Higher pro-BNP Levels Research Articles

Acute echocardiographic assessment of patients with ST-elevation myocardial infarction in detecting clinically hidden hemodynamic deterioration

Abstract Background Transthoracic echocardiography (TTE) offers an immediate non-invasive assessment of cardiac morphology and function that can be performed bedside. Acute TTE in the catheterization laboratory (cath.lab.) may be helpful to identify markers of subsequent development of cardiogenic shock (CS) in patients with ST-elevation myocardial infarction (STEMI) in addition to the previously validated ORBI risk score. This relationship has not been investigated thoroughly previously. Purpose To investigate the association between acute TTE estimates of left ventricular (LV) function prior to primary percutaneous coronary intervention (pPCI) in STEMI patients and pro-B-type natriuretic peptide (proBNP) as a proxy associated with of CS development. Method From September 2023 all non-CS STEMI patients at one tertiary heart center underwent acute bedside TTE in the cath.lab. and ORBI risk score assessing the risk of CS development aiming for inclusion of 500 patients. The 5 minutes TTE-protocol consisted of LV ejection fraction (EF), LV outflow tract velocity time integral (LVOT VTI), mitral inflow (E and E/A), mitral deceleration time, and mitral annular early diastolic velocity é lateral. The primary endpoint was proBNP measured 24 hours (h) after pPCI (12-36h) stratified in quartiles (Q4 vs. Q1-3). The correlation between proBNP and TTE measurements and proBNP and ORBI risk score was examined using univariate linear regression models. Results Until now 153 STEMI patients (mean age 64 years, 25% female) were studied. Anterior STEMI was present in 36%, and median time from cath. lab. arrival to first wire over the culprit lesion was 28 minutes (IQR 24; 37). Patients with high proBNP level (Q4 vs. Q1-3) had significantly higher heart rate (median 84 bpm vs. 72 bpm) and Killip Class>1 (16% vs. 0%) at admission, but similar lactate levels (1.8mM vs. 1.5mM), systolic blood pressure (130 mmHg vs. 137 mmHg), and out-of-hospital cardiac arrest (11% vs. 12%). Patients with high proBNP levels (Q4 vs. Q1-3) had significantly lower LVEF (35% vs. 50%), higher E/é lateral (median 11.4 vs. 7.9), and higher ORBI risk score (median 8 vs. 4). LVEF, LVOT VTI, E/é lateral, and ORBI risk score were significantly associated with proBNP (Figure 1). Two patients developed CS after the pPCI; one with high proBNP level Q4, and one deceased prior to proBNP measurement. Conclusion Acute TTE is an easy tool for assessment of the acute hemodynamic status in STEMI patients bedside in the cath.lab., and it can be without delaying time to revascularization. LVEF, LVOT VTI, E/é lateral, and ORBI were all parameters associated with increased levels of the hemodynamic biomarker proBNP, and may together with the ORBI risk score improve the assessment and risk stratification of STEMI-patients at risk of CS-development.Figure 1.

Clinical predictors of late left ventricle recovery in tako-tsubo syndrome

Abstract Funding Acknowledgements None. Introduction Tako-Tsubo syndrome (TTS) or stress cardiomyopathy is characterized by transient dysfunction of the left ventricle (LV) and a clinical presentation that can mimic an acute coronary syndrome. Recovery from contraction abnormalities may occur hours to weeks after the acute event. Although traditionally considered a disease with a favorable prognosis, it has been observed to have a complication rate during hospitalization similar to acute myocardial infarction and a significant mortality rate during follow-up (greater than 5% per patient-year). The recovery time of LV function has demonstrated important prognostic value. Purpose The aim of this work was to determine the clinical predictors of late left ventricular recovery in TTS. Methods Data from the multicenter national registry on Takotsubo Syndrome (RETAKO) were utilized. Clinical, laboratory, echocardiographic, and other imaging test characteristics, as well as events during hospitalization and follow-up, were collected. Recovery within the first days after the acute event was considered early recovery. Patients who died within the first 10 days after the acute event were excluded. Results A total of 1,463 patients were analyzed, of whom 373 (25.5%) had late recovery. The mean age was 71 years, and 86.6% were women. In the late recovery group, factors more common were age over 75 years, male gender, neurological disease, lung disease, peripheral arterial disease, active cancer, physical trigger, initial presentation as dyspnea or syncope, presence of shock, greater left ventricular dysfunction at diagnosis, and higher levels of proBNP. In multivariate analysis, the presence of neurological disease, active cancer, shock during hospitalization, lower initial LV ejection fraction, and physical trigger were associated with late recovery. Conclusions Patients with TTS showing late recovery of LV function have different clinical characteristics and disease presentation compared to those with early recovery. Late recovery was associated with the presence of neurological disease or active cancer, shock during hospitalization, lower initial LV ejection fraction, and physical trigger.

Role of Pro-BNP in predicting outcome in acute heart failure patient presenting to a medical emergency: An observational study from North India.

Acute heart failure (AHF) is a clinical syndrome defined as the new onset or acutely decompensated heart failure (ADHF) leading to signs and symptoms of heart failure (HF). The critical cut-off values for these biomarkers that suggest high mortality are not clearly defined in previous studies. More studies are required to better understand the correlation of Pro- BNP and its association with HF. The primary objective is to study the role of Pro-BNP and critical factors in predicting outcomes in AHF patients presenting to a medical emergency. The data from the patients presented with symptoms of HF in the Department of Medical Emergency at our hospital were recorded and analysed. AHF is a clinical syndrome defined as the new onset or ADHF leading to signs and symptoms of HF, as based on the European Society of Cardiology. The present study highlights the various risk factors of AHF in patients and their association with mortality. In the present study, mortality in patients with very high Pro-BNP levels ≥2000 pg/ml was significantly higher than in patients with moderately elevated Pro-BNP. The patients who survived after 5 days of hospitalization had Pro-BNP levels ≤2000 pg/ml, suggesting that very high Pro-BNP levels ≥2000 pg/ml are associated with fatal outcomes. To conclude, diabetes and sepsis are critical factors for the hospitalization and mortality of patients with AHF in northern India. Very high Pro-BNP levels ≥2000 pg/ml in patients with AHF requiring hospitalization and associated with fatal outcomes.

Evaluation of cardiac diagnostic tests findings based on pro-BNP levels in COVID-19 pregnant patients.

Pro-b-type natriuretic peptide (Pro-BNP) is an inflammatory marker that indicates cardiac damage and inflammation. The elevation of this marker in COVID-19 patients can be used as a predictive factor in the prognosis of these patients. Our cross-sectional study investigated the evaluation of cardiac diagnostic test findings based on pro-BNP levels in pregnant COVID-19 patients in Sayyad Shirazi Hospital, Gorgan, Iran, in 2020-2022. A hundred and ten pregnant patients diagnosed with COVID-19 infection were evaluated for cardiac diagnostic tests (electrocardiogram (ECG) and echocardiography (Echo)) and pro-BNP levels. Data were analyzed using SPSS 25 software. Chi-square and Student's t-test will be used to test and compare the relationship between variables and compare them. A P-value less than 0.05 is considered statistically significant. The chi-square test was used to compare the ratio of qualitative variables among the groups if the presuppositions of chi-square distribution were established. Otherwise, Fisher's exact test was used. The mean age of participants were 31.06 ± 5.533 years and 49.1% of patients had pro-BNP levels above the cut-off value for predicting an adverse outcome of COVID-19. The mean ± standard deviation of pro-BNP levels in the low group was 46.125 ± 17.523 pg/mL and in the high group was 878.814 ± 1038.060 pg/mL. This study revealed that patients with higher pro-BNP plasma levels had a significant relation between, myocardial infarction (MI), pericardial effusion (PE), urgent Caesarean section (C/S), and mortality. In addition, no significant relation between gravid, trimester, vaccination, arrhythmia, heart block, and valves diseases with high pro-BNP levels was found. The current research showed that pro-BNP levels can be used as a diagnostic and valuable prognostic tool in pregnant women to diagnose cardiac complications by using ECG and Echo.

Evaluation of troponin T levels and cardiac findings of the children in pediatric intensive care with high proBNP levels

Objective: Pro-B type brain natriuretic peptide (proBNP) is released from cardiac ventricular myocytes as a result of increased volume and pressure. Troponin T plays a role in the contraction process. Both proteins may be elevated in many cardiac and non-cardiac conditions. Our aim is to evaluate troponin T values and cardiac findings of the patients in pediatric intensive care unit (PICU) with elevated proBNP levels. Method: Patients with high proBNP values who were admitted to the PICU between January 2022 and January 2023 were included in the study. The clinical diagnoses, proBNP, and troponin T values were recorded. Information about the presence of heart disease and the status of systolic functions were obtained from echocardiographic examination reports. Results: One hundred and ten patients were included in the study. Mean age of the patients was 2.48±3.41 years. Among the patients hospitalized in the pediatric intensive care unit, 41% had lower respiratory tract infections, and 20% had heart disease. The mean proBNP values were 11827.06±12652.82 ng/l, and troponin T was 201.41±737.74 ng/l. Ejection fraction (EF) was normal in 75% of the patients. The mean values of proBNP and troponin T in the patients with normal EF were 7284.74±8437.16 ng/l and 49.67±73.15 ng/l while the mean values of proBNP and troponin were 25129±13659.24 ng/l and 645.8±1380.74 ng/l in the patients with decreased EF (p<0.05, for both). ProBNP and troponin T values of the patients with decreased EF accompanied with or without heart disease were higher than those in the group with normal EF without existing heart disease (p<0.0001, for all). It was observed that decreased EF value was more common in cases who have proBNP>16314 ng/l and troponin T >114 ng/l (p=0.0031, p<0.0001, respectively). Conclusion: ProBNP and troponin T values increase in many cardiac and non-cardiac diseases. However, quite high values of the parameters help to distinguish the patients with cardiac systolic dysfunction.

Cardiac biomarkers comparison between acute myocarditis/myopericarditis and multisystem inflammatory syndrome in children

Objectives: Acute myocarditis/myopericarditis is a heterogeneous disorder of unknown origin, the viral etiology leading the first row. There could be also myocardial involvement in multisystem inflammatory syndrome in children (MIS-C). In this study, we aimed to investigate cardiac biomarkers of acute myocarditis/myopericarditis and MIS-C and to compare these parameters between the two diseases. Methods: Patients who are diagnosed with MIS-C, isolated viral myocarditis/myopericarditis at a university hospital from October 2021 to March 2023 are included in this study. Results: There were 38 MIS-C patients and 53 patients with myocarditis/myopericarditis. The mean age was 141.2 ± 38.2 months (4 to 18 years old) in MISC, and 145.8 ± 52.1 months (7 to 18 years old) in myocarditis/myopericarditis. Median troponin I level was 145 ng/L in MIS-C patients and it was 901 ng/L in myocarditis/myopericarditis patients. Creatinine kinase-myocardial band (CK-MB) median was 2.25 ng/mL (0.6-6.3) versus 6.7 ng/mL in MIS-C and myocarditis/myopericarditis, respectively. Pro Brain natriuretic peptide (Pro-BNP) median level was 2714.5 pg/mL (<300) in MIS-C, and it was 294 in patients with myocarditis/myopericarditis. Troponin I, CK-MB was significantly higher in myocarditis/myopericarditis, while Pro-BNP was significantly higher in MIS-C patients (p < 0.05). The separating power of CK-MB, troponin I, and Pro-BNP level was significantly higher in the differential diagnosis of these two group patients (p < 0.001). MIS-C patients with high pro-BNP levels had more prolonged hospitalization and left ventricular function impairment according to myocarditis/myopericarditis. Conclusions: Cardiac biomarkers (CK-MB, troponin I, and Pro-BNP) could be good markers to estimate the course of the diseases.

The association between glycemia and clinical outcomes in patients with diabetes mellitus and pulmonary thromboembolism.

Various studies have shown that diabetes mellitus (DM) increases the risk of thrombosis in the venous system as well as in the arterial system. In this study, it was aimed to evaluate the association between admission blood glucose levels and clinical severity, recurrence, and mortality in pulmonary embolism in patients with DM. This study was designed as a retrospective cross-sectional study. Patients with DM who were admitted to a tertiary care hospital due to pulmonary embolism (PE) between 2014 and 2019 were included. Demographic characteristics, radiological findings, clinical class of embolism, and mortality data were retrieved from hospital records. Patients with and without recurrent disease, as well as patients who survived and died, were compared. Also, patients were classified according to quartiles of admission blood glucose levels. The quartiles were compared in terms of mortality, clinical, class, and recurrence. Two hundred ninety-three patients with DM and PE were included in the study. Patients with adverse outcome had significantly higher admission blood glucose levels (respectively, 197.9 ± 96.30 mg/dL vs. 170.7 ± 74.26 mg/dL; p = 0.03). Patients in the third and fourth quartile of admission blood glucose levels (>152 mg/ dL) had significantly more severe disease with a higher proportion of massive and sub-massive PE and higher pro-BNP levels (respectively, p = 0.01 and 0.02). Non-survived patients and recurrent disease were associated with higher admission blood glucose levels. Also, patients with admission blood glucose levels higher than 152 mg/dL tend to have clinically more severe diseases.

Correlation of mortality with Pro-BNP and precipitating factors of acute heart failure in patients presenting to a medical emergency of tertiary care hospital: an observational study from north India.

Acute heart failure is a syndrome defined as the new onset de novo heart failure or worsening [acutely decompensated heart failure (ADHF)] leading to symptoms and signs of HF, mostly related to systemic congestion as based on the European Society of Cardiology (ESC) definition. India has a huge burden of heart failure patients. Several factors have been identified as precipitating acute HF hospitalizations. These include myocardial ischemia, no adherence to medications, arrhythmias, infection, uncontrolled hypertension (HTN), anemia, renal impairment, and diet. However, there is a dearth of studies assessing their effect on mortality in patients admitted with acute heart failure. Many previous studies have shown that BNP and NT-pro-BNP are independent predictors of mortality and other cardiac outcomes in patients with heart failure (HF) and ADHF. However, no studies have provided any clear direction with respect to the critical cut-off values that suggest high mortality. Comprehensive knowledge of the correlation of Pro-BNP and precipitating factors of heart failure with mortality can help in prognostication and clinical management of AHF patients. This was a prospective observational cross-sectional study conducted in the Emergency Department of the Postgraduate Institute of Medical Education and Research, Chandigarh which is a teaching and research hospital located in North India. Patients were enrolled from 1st August 2021 to 28th February 2022. Patients who met inclusion criteria were enrolled; they were followed for 5 days. After 5 days outcomes were recorded. Various precipitating factors for hospitalization were identified and their clinical impact on mortality was noted. Pro-BNP values were obtained at admission and their correlation with mortality and patient outcome after 5 days was noted. Values of Pro-BNP were compared among those who survived after 5 days vs. those who had fatal outcomes. The most common precipitating factor for AHF was poor medical compliance which did not affect mortality. It was followed by sepsis which significantly increases mortality in patients of AHF. ACS was also an important precipitating factor for AHF, though it had no effect on mortality. The mortality in the group of patients with very high Pro-BNP levels ≥ 2000 pg/ml was significantly higher than in the group of patients who had moderately elevated Pro-BNP < 2000 pg/ml. The median value of Pro-BNP was significantly higher in patients who had fatal outcomes [3670 (IQR- 2745 to 3980)] as compared to patients who survived after 5 days of hospitalization [1340 (IQR- 987 to 1670)]. Poor compliance with medications and sepsis are the most common precipitating factors for acute heart failure in north Indian patients. Sepsis as a precipitating factor is a significant risk factor for in-hospital mortality in acute heart failure patients presenting to the emergency department. Pro-BNP values above 2000 pg/ml in patients with acute heart failure requiring emergency admission are associated with a poor prognosis.

Predictors of readmission in hospitalized heart failure patients

Introduction: Heart failure(HF) related hospitalization constitutes a significant proportion of healthcare cost. Unchanging rates of readmission during recent years, shows the importance of addressing this problem. Methods: Patients admitted with heart failure diagnosis in our institution during April 2018to August 2018 were selected. Clinical, para-clinical and imaging data were recorded. All included patients were followed up for 6 months. The primary endpoints of the study were prevalence of early readmission and the predictors of that. Secondary end points were in-hospital and 6-month post-discharge mortality rate and late readmission rate. Results: After excluding 94 patients due to missing data, 428 patients were selected. Mean age of patients was 58.5 years (±17.4) and 61% of patients were male. During follow-up, 99patients (24%) were readmitted. Early re-admission (30-day) occurred in 27 of the patients(6.6%). The predictors of readmission were older age (P = 0.006), lower LVEF (P <0.0001), higher body weight (P = 0.01), ICD/CRT implantation (P = 0.001), Lower sodium (P = 0.01), higher Pro-BNP(P = 0.01), Higher WBC count (P = 0.01) and higher BUN level (P = 0.02). Independent predictors of early readmission were history of device implantation (P = 0.007), lower LVEF (P = 0.016), QRS duration more than 120 ms (P = 0.037), higher levels of BUN (P = 0.008), higher levels of Pro-BNP(P = 0.037) and higher levels of uric acid (P = 0.035). Secondary end points including in-hospital and 6-month post-discharge mortality occurred in 11% and 14.4% of patients respectively. Conclusion: Lower age of our heart failure patients and high prevalence of ischemic cardiomyopathy, necessitate focusing on more preventable factors related to heart failure.

The Investigation of Endomyocardial Biopsy Results, Plasma pro-BNP Levels and Non-invasive Parameters for Diagnosing of Acute Rejection in Patients Who Undergo Cardiac Transplantation

Aim: Heart failure is a disease with high mortality and morbidity, reducing the patient's quality of life. Each year 10% of heart failure patients progress to end-stage heart failure. Cardiac transplantation is the gold standard treatment method in these patients, however acute rejection is the most important factor affecting the success of this treatment. In this study, it was aimed to evaluate endomyocardial biopsy results, serum pro-BNP and non-invasive parameters in patients with acute rejection following cardiac transplantation.Patients and Methods: Twenty patients who underwent cardiac transplantation in our center were included in the study. The patients were divided into two groups, namely acute rejection (n: 10) and without rejection (n: 10). Echocardiography, electrocardiography (ECG), endomyocardial biopsy results, serum reactive proteins (CRP), sedimentation rate and serum pro-BNP levels, were evaluated among the patients and compared between the groups.Results: Endomyocardial biopsies obtained from patients with acute rejection revealed grade 1 rejection in 6 (60%) patients, grade 2 in 3 (30%) patients and grade 3 rejection in 1 (10%) patients. CRP and sedimentation rate were found to be similar between the groups (p&amp;gt; 0.05). High pro-BNP levels were found in patients with rejection (4843.20 ± 6690.10 pg / ml) when compared to the control group (496.30± 216.20 pg / ml) (p: 0.001). In addition, higher pro-BNP levels were detected with progressing of rejection grade (p: 0.03). The highest pro-BNP level was found in a patient with Grade-3 rejection (15211 pg / ml, p: 0.000).Conclusion: Our results show that serum pro-BNP levels are associated with acute rejection. In addition, higher pro-BNP levels were found to be associated with advanced rejection levels.

P983When should we measure biomarkers in patients with atrial fibrillation to predict recurrences?

Abstract Funding Acknowledgements No grants to declare Background Atrial fibrillation (AF) in the most frequent arrhythmia. Remodeling and fibrosis phenomena are implicated in its development. ProBNP, galectin-3, ST2, urate, C reactive protein, troponin and fibrinogen are some biomarkers (BM) involved in these processes. Purpose The aim of our study was to assess the implication of these BM in the recurrence of AF after an electrical cardioversion (ECV) and if the relation depends on the moment that they are measured. Methods We included 115 patients with persistent AF who underwent an ECV. We performed a 6-months (M) -follow-up. We assessed our patients in a clinical, analytical (a blood sample was extracted pre-ECV and at 6M) and electrocardiographic (with holter at 3M and an ECG at 6M). Any documentation of AF during the follow-up was defined as a recurrence. We assessed the relation between basal BM and recurrence by Kaplan-Meier method and the relation between BM at 6M and recurrence by tStudent with normal variables and U-Mann-Withney with no-normal ones. We performed a ROC curve with those BM that show statistical significance in order to define the best cut-off point to classify our patients. We also made a logistic regression analysis to assess the existence of independent association between BM and recurrence. Results 71 patients had a recurrence (61.73%). These patients were older than those who did not, without any other significant clinical difference between both groups. None of the basal BM was related to recurrence during the follow-up. ProBNP and ST2 at 6M were significantly related to recurrence. ProBNP showed an area under the ROC curve of 0.774 (figure 1). The best cut-off point for proBNP was 300 pg/ml (sensibility (S) 72%, specificity (Sp) 72%) and for ST2 30.73 ng/ml (S 66% and Sp 58%). Only proBNP was independently related to recurrence (OR: 10.90; CI (3.87-30.75), P &amp;lt; 0.001. Conclusions BM measured pre-ECV do not predict recurrences in the follow-up, so they should not be used with that purpose. Those patients that suffered recurrence had higher levels of proBNP (distension BM) and ST2 (remodeling BM) measured at 6M. These 2 processes might be the most important pathophysiological factors in the maintenance of AF. The repeated measurement of these BM could lead the most accurate management in these patients. Abstract Figure.

Impact of Pulse Pressure on Hemocompatibility Related Adverse Events during Support with Continuous Flow Left Ventricular Assist Devices: An Analysis of the INTERMACS Registry

While the impact of mean arterial pressure (MAP) on adverse events during left ventricular assist device (LVAD) support has been well established, there remains significant controversy regarding the impact of pulse pressure (PP) on clinical outcomes. We evaluated the impact of PP on post-implant hemocompatibility related adverse events (HRAE). Using the INTERMACS registry, we identified patients who received a primary, durable continuous-flow LVAD with distinct systolic and diastolic blood pressure readings at 3-months post-implant. Patients requiring mechanical right ventricular assist devices or inotropic support were excluded. Patients were then stratified into low, medium, and high pulsatility tertiles. Kaplan-Meier survival estimates and Cox Proportional Hazard Models were used to assess the impact of pulsatility on HRAEs. A total of 4745 patients were classified into low (n=1508), medium (n=1675), and high (n=1562) pulsatility groups. There was no correlation between PP and MAP in this population (Figure 1A) and no clinically significant difference in MAP between the groups. Significant pre-implant determinants of pulsatility included female sex, BMI, race, device type, and peripheral vascular disease. Patients with lower pulsatility had more RV dysfunction and higher pro-BNP levels as compared to those with higher pulsatility. PP was a significant risk factor for stroke (HR: 1.09, CI: 1.04 - 1.15, p=0.001 per 10mmHg increase) independent of MAP. Patients with high MAP and high PP had the highest stroke risk (Figure 1B). PP was not associated with GI bleeding, device thrombosis. thromboembolic events, or post-implant survival. High PP is associated with increased risk of stroke during LVAD support. Pulsatility may represent an additional therapeutic target in this patient population.

Clinical Significance of Late Onset Arthritis in Kawasaki Disease

Objectives: The aim of this study was to report the prevalence, clinical course, and sequela of arthritis in Kawasaki disease (KD), and to establish its relationship to coronary outcomes. Methods: We retrospectively reviewed the records of 524 patients between March 2006 and February 2016. Results: The overall prevalence of arthritis was 17.6 % (n = 92/524) and among them, 21 cases (22.8%) had late-onset arthritis and they were older (32.7 ± 12.1 vs. 62.5 ± 23.8 months), had longer fever duration (5.8 ± 1.94 vs. 7.11 ± 2.51 days), more frequent swelling or redness of extremities (35.2 vs. 71.5%), higher neutrophil counts (58.69 ± 13.84 vs. 72.16 ± 16.43%), and higher prohormone brain-type natriuretic peptide levels (ProBNP, 1343.80 ± 1080.44 vs. 3754.42 ± 4272.71 pg/mL) than patients with early onset arthritis. Coronary artery changes were not different and no patients complained of chronic arthritic changes, regardless of arthritis type. Conclusions: Although late-onset arthritis was found in KD patients who were older with longer fever duration, more frequent swelling or redness of extremities, higher neutrophil counts, and higher ProBNP levels than early-onset arthritis patients, there was no statistical significance between arthritis onset type and coronary artery changes, and outcomes were excellent with no chronic arthritis change.

PS196. Increased Adipose-Derived Mesenchymal Stem Cells Counts and Pro-B-Type Natriuretic Peptide in Patients With Critical Limb Ischemia

Mesenchymal stem cells (MSCs) have been shown to improve regeneration of injured tissues in vivo. Several in vitro studies and animal models have demonstrated improvement in MSCs paracrine effects under hypoxic conditions. Moreover, several studies suggested that the pro B-type natriuretic peptide (pro-BNP) could be involved in the stimulation of postischemic vascular regeneration. The purpose of this study was to investigate the effect of critical limb ischemia, in a human model, on in situ adipose-derived mesenchymal stem cells (ADMSCs) and to determine whether serum levels of N-terminal pro-BNP correlate with ADMSCs counts and associated paracrine effects. Lipoaspirate samples of ≥10 mL were collected from ischemic limbs (ischemic group) and compared with control samples (without ischemia). MSCs were characterized by frequency, viability, differentiation potential, cytokines expression, and cell surface markers. Serum NT pro-BNP was measured as well. MSCs counts were ninefold to 10-fold higher in patients with ischemic limbs (mean 7952 ± 542 MSC/mL) than controls (mean 790 ± 65 MSC/mL). Pro-BNP levels (range, 1878-4757 pg/mL) were approximately eightfold to 26-fold higher than in age- and sex-matched controls. Furthermore, there were positive correlations between pro-BNP levels and MSCs counts in the ischemic group. Patients with critical limb ischemia (CLI) have higher levels of pro-BNP and MSCs counts than controls. Increased levels of pro-BNP and MSCs counts can be considered humoral and cellular surrogates of ischemia and hypoxia in patients with CLI. This supports recent studies that suggest that the increase production of peripheral BNP may be a stem cells-mediated response to stimulate angiogenesis in the ischemic skeletal muscles.

Abstract 182: Increased Adipose-Derived Mesenchymal Stem Cells Counts and Pro-B-Type Natriuretic Peptide in Patients With Critical Limb Ischemia

Mesenchymal stem cells (MSCs) have been shown to improve regeneration of injured tissues in vivo. Several in vitro studies and animal models have demonstrated improvement in MSCs paracrine effects under hypoxic conditions. Moreover, several studies suggested that the pro B-type natriuretic peptide (pro-BNP) could be involved in the stimulation of postischemic vascular regeneration. The purpose of this study was to investigate the effect of critical limb ischemia, in a human model, on in-situ adipose derived mesenchymal stem cells (ADMSCs) and to determine whether serum levels of N-terminal pro-BNP correlate with ADMSCs counts and associated paracrine effects. Lipoaspirate samples of ≥ 10mL were collected from ischemic limbs (ischemic group) and compared to control (without ischemia). MSCs were characterized by frequency, viability, differentiation potential, cytokines expression, and cell surface markers. Serum NT pro-BNP was measured as well. MSCs counts were 9-to-10-fold higher in patients with ischemic limbs (mean 7952 MSC/mL ± 542) than controls (mean 790 MSC/mL ± 65). Pro-BNP levels (1878-4757 pg/mL) were approximately 8-to-26-fold higher than in age- and sex-matched controls. Furthermore, there were positive correlations between pro-BNP levels and MSCs counts in the ischemic group. In conclusion, patients with critical limb ischemia (CLI) have higher levels of pro-BNP and MSCs counts than controls. Increased levels of pro-BNP and MSCs counts can be considered humoral and cellular surrogates of ischemia and hypoxia in patients with CLI. This supports recent studies that suggest that the increase production of peripheral BNP may be a stem cells-mediated response to stimulate angiogenesis in the ischemic skeletal muscles.

Abstract P032: Adiponectin is Significantly Associated with NT-pro BNP Levels: The Multi-Ethnic Study of Atherosclerosis

Background: Increasing adiposity results in an increase in intravascular volume, while natriuretic peptides increase in response to pressure and volume overload. Adiponectin and leptin are cytokines released from adipose tissue (adipokines) that have purportedly opposite associations with CVD and measures of left ventricular structure and function. Methods: Subjects were 1970 individuals enrolled in the Multi-Ethnic Study of Atherosclerosis who were without clinical CVD at baseline and evaluated by extensive survey information, relevant physical measurements and fasting venous blood that was analyzed for NT-pro BNP (proBNP) and the adipokines adiponectin and leptin. proBNP was assayed from two different study visits about 4 years apart. Results: At baseline, the mean age was 64.8 years and 48% were female. Forty-two percent were White, 26% Hispanic American, 18% African American and 14% Chinese American. Median values for adiponectin, leptin and proBNP were 17.3 μg/ml, 13.1 ng/ml and 66.7 pg/ml, respectively, while the median change in proBNP was 11.6 pg/ml. With adjustment for traditional CVD risk factors, adiposity, renin, aldosterone and LV mass and volume, a 1-SD increment in adiponectin was associated with a 13.7 pg/ml higher proBNP level (p &lt; 0.01), while, compared to the 1st quartile of adiponectin, the 2nd, 3rd and 4th quartiles were associated with 28, 45 and 67% higher proBNP levels (p &lt; 0.01 for all). For changes in proBNP over the follow-up period, and after multivariable adjustment including baseline proBNP, a 1-SD increment in adiponectin was associated with a 25 pg/ml increase in proBNP (p &lt; 0.01), while those in the 2nd, 3rd and 4th quartiles of adiponectin were associated increases of 5, 28 and 65 pg/ml (p = 0.74, 0.09 and &lt; 0.01, respectively). There were no significant multiplicative interactions by race or obesity status. However, there was a significant interaction between adiponectin and gender for proBNP, such that the associations detailed above were significantly stronger in men. Leptin was not associated with proBNP (data now shown). Conclusions: Higher adiponectin, but not leptin, is significantly associated with higher levels of proBNP, as well as significant longitudinal increases in proBNP. The findings appear to be stronger in men.

CA 125 levels and left ventricular function in patients with end-stage renal disease on maintenance hemodialysis

Purpose: The aim of this study was to analyze associations between serum cancer antigen 125 (CA 125) levels and left ventricular (LV) function in patients with end-stage renal disease on maintenance hemodialysis (HD). Methods: CA 125 levels, pro-brain natriuretic peptide (pro-BNP) and biochemical parameters were measured, and echocardiography was performed for 110 patients and 47 healthy controls. Results: The mean CA 125 level in patients, 38.78 ± 35.48 U/mL, was significantly higher than that found in healthy controls (9.20 ± 4.55 U/mL; p = 0.003). Patients with elevated CA 125 levels (n = 40) had significantly lower levels of albumin and reduced relative wall thickness, LV ejection fraction (EF) and fractional shortening but significantly higher levels of pro-BNP and a greater left ventricular end-diastolic diameter (LVEDd) and -systolic diameter (LVESd). CA 125 levels were positively correlated with pro-BNP (r = 0.596, p < 0.05) and C-reactive protein (CRP) levels (r = 0.439, p < 0.05), as well as LVEDd (r = 0.599, p < 0.001), LVESd (r = 0.750, p < 0.001) and LV mass index (r = 0.378, p < 0.05). In contrast, serum CA 125 levels were negatively correlated with albumin (r = −0.513, p < 0.05) and hemoglobin (r = −0.475, p < 0.05) as well as the EF (r = −0.878, p < 0.0001). A depressed EF (β = −1.121, p < 0.0001) and increased CRP levels (β = 0.247, p = 0.035) were independent predictors of high CA 125 levels in the whole group in the multivariate-model. Conclusions: Our study is the first to demonstrate an association between serum CA 125 levels and LV systolic dysfunction via inflammation in patients on maintenance HD.

High pro-BNP levels predict the occurrence of atrial fibrillation after cryptogenic stroke

High pro-BNP levels predict the occurrence of atrial fibrillation after cryptogenic stroke

Pulmonary Hypertension in Hypertensive Patients: Association with Diastolic Dysfunction and Increased Pulmonary Vascular Resistance

Pulmonary hypertension (PH) in patients with systemic hypertension and preserved ejection fraction (PEF) has been described. However, the pathophysiology and consequences are not entirely clear. We sought to distinguish the clinical and anatomic features among hypertensive patients with or without coexistent PH. Echocardiograms and records of hypertensive patients with left ventricular (LV) hypertrophy and PEF from January 2009 to January 2011 were reviewed. We identified 174 patients, including 36 with PH (calculated pulmonary artery systolic pressure [PASP] ≥ 35 mmHg), and 138 with normal pulmonary pressures. Hypertensive patients with PH were older (76 ± 13 vs. 65 ± 13 years, P < 0.0001), more often female (91, 70%), had lower estimated glomerular filtration rate (eGFR) (63 ± 44 vs. 88 ± 48 mL/min, P = 0.002), and higher pro-BNP levels (3141 ± 4253 vs. 1219 ± 1900 pg/mL, P = 0.003). PH patients also had larger left atrial areas (23.7 ± 3.8 vs. 20.8 ± 4.6 cm(2) , P = 0.002), evidence of diastolic dysfunction (i.e., septal E/e' 17.6 ± 8.6 vs. 12.7 ± 4.4, P = 0.0005), and higher calculated peripheral vascular resistance (PVR) (2.3 ± 1.1 vs. 1.6 ± 0.4, P < 0.0001). Both PVR and septal E/e' showed strong linear correlation with PASP (P < 0.0001 and P < 0.0001, respectively). Hypertension in elderly patients is frequently complicated by LV diastolic dysfunction and secondary PH. These hypertensive patients tended to have reduced renal function and higher pro-BNP. Because of the known morbidity and mortality associated with PH, these observations have potentially important implications for target medical therapy.

TCT-697 Outcomes from MitraClip Therapy in Functional Compared to Degenerative Mitral Regurgitation: Multi-centre Experience from the MitraClip Asia-Pacific Registry (MARS)

events included: IABP support (13%), renal replacement therapy (6%), infections (3.6%). No cerebrovascular events or AMI occurred. Median length of hospital stay was 5 days. At discharge, 87% patients had MR 2+. At 1 year months EF was 34.7 10.4% (p1⁄40.002 compared to baseline value). Actuarial survival at 1 year was 89.6 3%. Actuarial freedom from MR 3+ at 1 year was 79.4 4%. At 1 year, MLHFQ improved from 40 15 to 22 16 (p<0.0001). Complete QoL restoration at 1 year was achieved in 43% of the survivors. At multivariate analysis, preoperative value of serum pro-BNP 1600 pg/ml was identified as independent predictors of QoL restoration at 1 year (OR 0.2; p1⁄40.03). Conclusions: MitraClip therapy is a safe and effective therapeutic option for high-risk patients with FMR, leading to clinical and QoL improvements. Higher pro-BNP levels are associated with reduced likelihood of QoL restoration at 1 year.