Higher Brain Natriuretic Peptide Research Articles

Long-term cardiovascular prognosis after rotational atherectomy in hemodialysis patients: Data from the J2T multicenter registry

BackgroundHemodialysis (HD) patients have heavy calcium deposits in their stenotic coronary arteries and worse post-percutaneous coronary intervention (PCI) prognoses than those who do not undergo HD. Rotational atherectomy (RA) facilitates PCI success in severely calcified lesions. We aimed to identify clinical and procedural characteristics that predict HD patients' long-term prognoses after PCI that included RA in the drug-eluting stent (DES) era. MethodsThis study included 302 patients who underwent regular HD from J2T Multicenter Registry database of 1090 consecutive patients who underwent RA to treat de novo calcified lesions at three university hospitals between 2004 and 2015. The primary endpoint was cardiovascular (CV) death. ResultsDuring the 5-year observation period, 59 CV deaths (19.5%) occurred. The CV death group and non-CV death group had comparable profiles except significantly lower left ventricular ejection fraction, higher brain natriuretic peptide (BNP), lower rate of RA burr upsizing, and lower rate of final thrombolysis in myocardial infarction (TIMI) 3 flow achievement in the CV death group. Cox regression analysis revealed that increasing ablation burr size (hazard ratio [HR]: 0.33; 95% confidence interval [CI]: 0.13–0.81), final TIMI 3 flow (HR: 0.07; 95% CI: 0.02–0.28), lower BNP level, and optimal medication were independently associated with better CV mortality in HD patients. ConclusionIn the DES era, oral medications at the time of PCI and stepwise calcium ablation were associated with improved long-term CV mortality in HD patients who are scheduled to undergo RA to treat severely calcified coronary artery stenoses, as therapeutic strategies.

B-type peptides to predict post-liver transplant mortality: systematic review and meta-analysis.

Cirrhotic patients undergoing liver transplantation are at risk of cardiac complications. Brain natriuretic peptide (BNP) and amino terminal brain natriuretic peptide (NT-BNP) are used in cardiac risk stratification. Their significance in predicting mortality risk in cirrhotic patients during or after liver transplantation is unknown. We conducted a systematic review and meta-analysis to answer this question. An electronic search of EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews (2005-September 2016), Google Scholar, and study bibliographies was conducted. Study quality was determined, and demographic and outcome data were gathered. Random effects meta-analyses of mortality-based BNP and NT-BNP level or presence of post-transplant heart failure were conducted. Seven studies including 2,010 patients were identified. Demographics were similar between patients with high or low BNP or NT-BNP levels. Hepatitis C was the most prevalent etiology of cirrhosis (38%). Meta-analysis revealed a pooled relative risk of 3.1 (95% CI 1.9% to 5.0%) for post-transplant mortality based on elevated BNP or NT-BNP level. Meta-analysis also revealed a pooled relative risk of 1.6 (95% CI 1.3% to 2.1%) for post-transplant mortality if patients had demonstrated post-transplant heart failure. Our analysis suggests that BNP or NT-BNP measurement may help in risk stratification and provides data on post-operative mortality in cirrhotic patients undergoing liver transplantation. Discriminatory thresholds are higher in cirrhotic patients relative to prior studies with non-cirrhotic patients. However, the number of analyzed studies is limited, and our findings should be validated further through larger, prospective studies.

Abstract TP570: Cerebrovascular Risk Factors in Elderly Patients With Alzheimer’s Disease

Background: Since disease modifying therapy is not yet available in our current medical practice against dementia including Alzheimer’s disease (AD), the management of vascular risk factors (VRFs) is regarded as the most practical way in the prevention and treatment of dementias. In this paper, the influence of VRFs including cerebrovascular lesions were analysis in relation to the cognitive function in elderly AD patients. Subjects and Methods: The present study was conducted based on 111 Japanese patients (37 men and 74 women) with probable AD who visited our memory clinic. None of them experience stroke events. Their mean age was 75.7 years, and the mean MMSE was 19.0. All subjects underwent 1.5 Tesla MRI, neuropsychological evaluation and laboratory tests including brain natriuretic peptide (BNP) and APOE status. Hypertension, diabetes, obesity, dyslipidemia, heart failure, coronary artery disease, atrial fibrillation (AF) and frailty were regarded as VRFs. Results: The mean MMSE score was highest in 4 cases who had no VRF, whereas that was lowest in 11 cases (9.1%) who had 4 or more VRFs. On MRI, 56 cases (50.5%) showed old lacunar infracts, and 18 cases (16.2%) had old microbleeds. The mean MMSE score was 17.5 in those with thalamic infarcts, whereas that was 19.3 in those without thalamic lesions. Severe white matter lesions and AF were also associated lower cognitive score. The mean MMSE was 18.5 in the underweight cases (BMI<20), whereas that was 20.5 in overweight subjects. Those with the lowest BNP quartile showed the highest MMSE score, whereas the highest BNP quartile had lowest MMSE score. For both systolic and diastolic blood pressure, those in the lowest tertile showed lower MMSE score as compared with those in the highest tertile. Conclusion: The cerebrovascular risk factors including thalamic infarcts, severe white matter lesions, heart failure, AF, and frailty influenced on the clinical presentation in elderly AD patients.

Can Admission BNP Level Predict Outcome After Intravenous Thrombolysis in Acute Ischemic Stroke?

Our study aimed to determine the prognostic value of elevated Brain Natriuretic Peptide (BNP) among patients who received intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). The elevation in BNP level is correlated with infarct size, poststroke mortality, and CHADS2 score. Currently, there is a lack of validated biomarker to predict the outcome in patients with acute ischemic stroke, and there is a complex interaction amongst multiple variables. A retrospective review of medical records of patients admitted to our institution with acute ischemic stroke was performed. The patients who received intravenous thrombolysis were selected for analysis and divided into 2 groups based on the level of BNP. We compared the baseline demographics, past medical history, stroke etiology, discharge disposition, and 3-month mRS between both groups. Multivariate logistic regression analysis was performed to identify the predictors of poor outcome following intravenous thrombolysis in acute ischemic stroke. A total of 90 patients were recruited in the study; 53 patients were found to have an elevated BNP (high BNP was defined as >100 pg/mL) level, whereas 37 had low BNP levels. Our study showed that patients with elevated BNP were more likely to have an elevation in admission and discharge NIHSS, serum creatinine, left atrial size, and blood glucose (P<0.05). Atrial fibrillation and cardioembolic strokes were seen most often in the population with elevated BNP (P<0.05). The patients with elevated BNP were less likely to be discharged home, and 3-month mRS was found to be higher, but these were not significant. On multivariate analysis, elevated BNP was not found to be an independent factor for poor outcome. Elevated BNP level was not found to be an independent marker of poor outcome in AIS patients following IVT.

High brain natriuretic peptide is associated with sarcopenia in patients with type 2 diabetes: a cross-sectional study of KAMOGAWA-DM cohort study.

Association between heart failure and sarcopenia has been reported, however, the association between sarcopenia and brain natriuretic peptide (BNP) is unclear. Thus, we investigated the association between sarcopenia and BNP in type 2 diabetic patients without heart failure. In this cross-sectional study, skeletal muscle mass index (SMI, kg/m2) was calculated as appendicular muscle mass, measured by bioimpedance analyzer, by the square of the height. Sarcopenia was defined as having both handgrip strength of <26 kg for men and <18 kg for women, and SMI of <7.0 kg/m2 for men and <5.7 kg/m2 for women. To investigate the impact of BNP levels on the presence of sarcopenia, propensity-score matching analysis was used to remove the bias of confounding variables, including age, sex, duration of diabetes, body mass index, exercise, systolic blood pressure, smoking status, hemoglobin A1c, creatinine, energy and protein intake. The area under the curve (AUC) of BNP levels for the presence of sarcopenia was calculated by the receiver operating characteristic curve (ROC). Among 433 patients (236 men and 65.4 (11.1) years), 32 patients (7.4%) were diagnosed as sarcopenia. In the propensity-matched 58 patients, BNP levels (Δ10 pg/mL incremental) were associated with the presence of sarcopenia by logistic regression analysis, (odds ratio: 1.56, 95% confidence interval: 1.14-2.13, p = 0.002). The optimal cut-off point of BNP levels for sarcopenia is 27.3 pg/mL (AUC 0.777, 95%CI, 0.691-0.863, sensitivity = 0.813, specificity = 0.736, p < 0.001). In conclusion, BNP levels were associated with sarcopenia in type 2 diabetic patients without heart failure.

Investigation of the relationship between hospitalization periods in patients with acute coronary syndrome

Aim: The aim of this study was to investigate the relationship between high sensitivity C-reactive protein (HsCRP), cardiac markers, D-dimer and brain natriuretic peptide (BNP) measured at admission to the emergency department in patients with acute coronary syndrome (ACS).Material and Methods: In our clinic, patient records were scanned backwards. The records of the patients who presented to the emergency department with chest pain were evaluated. Patients with acute coronary syndrome were included in the study. Laboratory values, echocardiogram and electrocardiograms of these patients were examined.Results: 88 patients with acute coronary syndrome were included in our study. According to the complaints of the patients, 93.2% (n=82) had chest pain, 45.5% (n=40) sweating, and 42% (n=37) had left arm pain at their admission to the emergency unit. The mean stick blood glucose value of the patients who came to our emergency department was 157±75.38 mg / dl (37.00-524.00 mg / dl). Biochemical laboratory values measured from venous blood taken at the time of arrival of patients, mean HsCRP 11.67±15.4 mg / l, insulin 14.87±29.53 IU / ml, glucose level 139.11±74.3 mg / dl, CK 426.9±12x8.9 mg / dl and CK-MB were determined as 41.1±46.8 mg / dl.Conclusion: We conclude that there is no correlation between cardiac parameters, DDIM, glucose, insulin and HsCRP levels in the in-hospital prognosis and there is a relationship between the measured BNP levels and the length of hospital stay.Keywords: Emergency service; trauma; blood glucose; DDIM.

Role of serum levels of intraoperative brain natriuretic peptide for predicting acute kidney injury in living donor liver transplantation.

BackgroundPatients with end-stage liver disease frequently experience acute kidney injury (AKI) after living donor liver transplantation (LDLT). Serum levels of brain natriuretic peptide (BNP) have increasingly been accepted as a predictor of AKI in clinical settings. This study investigated the predictive role of intraoperative BNP levels in the early development of AKI after LDLT.Patients and methodsAdult patients (≥19 years old) who had undergone elective LDLT from January 2011 to December 2017 were classified into the non-AKI and AKI groups according to the Kidney Disease: Improving Global Outcomes criteria. Serum levels of BNP were measured three times in the preanhepatic, anhepatic, and neohepatic phases. Perioperative data in recipients and donors were analyzed retrospectively.ResultsSixty-one patients (22.4%) suffered from AKI immediately after LDLT. Severity according to AKI stage was as follows: 28 patients in stage 1 (10.3%), 18 patients in stage 2 (6.6%), and 15 patients in stage 3 (5.5%). In the neohepatic phase, both BNP levels and proportions of patients with high BNP levels (≥100 pg/mL) were higher in the AKI group than in the non-AKI group. Only BNP levels in the non-AKI and AKI stage 1 groups significantly decreased from the preanhepatic phase to the neohepatic phase; those in AKI stages 2 and 3 groups did not. In particular, BNP levels of all AKI stage 3 patients increased to more than 100 pg/mL, and the proportion of patients with high levels also increased significantly through the surgical phases in the AKI stage 3 group. In multivariate analyses, BNP levels in the neohepatic phase were significantly associated with early development of AKI after LDLT, as well as the total amount of packed red blood cells in transfusions and total duration of graft ischemia.ConclusionsMonitoring serum levels of BNP is useful for predicting the early development of AKI after LDLT.

Abstract 291: Galectin-3 as a Risk Predictor of Short-Term Mortality in the Resuscitated Cohorts of Out-of-Hospital Cardiac Arrest

Introduction: Out of Hospital Cardiac Arrest (OHCA) is a common and catastrophic manifestation of multiple cardiac and non-cardiac illnesses. Recent studies showed increase in survival rate, reaching to about one third of those who suffer a bystander witnessed OHCA with a shockable rhythm; yet biomarkers to predict outcomes in this group is still missing. Hypothesis: We tested the hypothesis that serum galectin-3, alone or together with galectin-3 binding protein (G3BP),brain natriuretic peptide (BNP) and troponin, can predict the risk of early (30-day) mortality in ResCOHS. Methods: ResCOHS prospective multicenter pilot study enrolled 117 patients with aborted out-of-hospital cardiac arrest, and 10 healthy volunteers. Transthoracic Echocardiogram was performed for cardiac morphology and function. Serum levels of galectin-3, G3BP, BNP and peak troponin were analyzed. Patients were prospectively followed up for 30-days to determine all-cause in-hospital mortality. Results: Among the ResCOHS, patients who died within 30-days had higher BNP and galectin-3 levels, with no differences in the G3BP, peak troponin, CK and CK-MB levels. Receiver operating characteristic analysis for mortality prediction showed that, for 30-day prognosis, galectin-3 had the greatest area under the curve (AUC) at 0.764 (p = 0.001), whereas G3BP, BNP and troponin had an AUC of 0.518 (p = 0.735), 0.759 (p = 0.001)and 0.540 (p=0.460) respectively. In a multivariate logistic regression analysis, an elevated level of galectin-3 was the strongest independent predictor of 30-day mortality (odds ratio 1.04, p = 0.002). The Kaplan-Meier analyses showed that the combination of an elevated galectin-3 with NT-proBNP was a better predictor of mortality than either of the 2 markers alone. Conclusions: In the ResCOHS, higher serum galectin-3 levels are associated with increased chances of death within 30-days of the first episode of cardiac arrest. These findings have implications to target specific therapies to those at the greatest risk of mortality after OHCA.

Features of Patients Aged 80 Years or Older with Embolic Stroke of Undetermined Source

Background: Embolic stroke of undetermined source has not been thoroughly investigated in older patients. In this study, we investigated the features of this condition in patients greater than or equal to 80 years of age. Methods: All patients with acute ischemic stroke in our hospital underwent diffusion-weighted imaging, magnetic resonance angiography, T2-weighted imaging, and fluid-attenuated inversion recovery sequence imaging. Embolic stroke of undetermined source was defined as a radiologically confirmed nonlacunar brain infarct on diffusion-weighted imaging without (1) extracranial or intracranial atherosclerosis causing greater than or equal to 50% luminal stenosis in arteries supplying the ischemic area, (2) major-risk cardioembolic source, and (3) any other specific cause of stroke. We retrospectively identified consecutive patients hospitalized for acute ischemic stroke who met the embolic stroke of undetermined source diagnostic criteria and investigated patients’ baseline and diagnostic findings. Results: We divided 122 consecutive embolic stroke of undetermined source patients (median age: 73 years; 49 men, 73 women) into 2 groups by age at admission. Patients aged greater than or equal to 80 years had higher D-dimer and brain natriuretic peptide levels, more frequent premature atrial complexes/day in 24-hour Holter electrocardiography, and thicker maximum intima media thickness on ultrasound compared with patients aged less than 80 years (P < .05, U test). Conclusions: Our results suggest that high admission D-dimer and brain natriuretic peptide levels are associated with age of onset in patients with embolic stroke of undetermined source. Patients aged greater than or equal to 80 years tended to have more frequent premature atrial complexes and thicker maximum intima media thickness compared with patients aged less than 80 years.

Analysis of the risk factors of acute kidney injury in patients receiving extracorporeal membrane oxygenation .

Acute kidney injury (AKI) during extracorporeal membrane oxygenation (ECMO) affects the prognosis of patients. In the present study, we explored the risk factors for AKI through a retrospective analysis of relevant data of patients undergoing ECMO with AKI. Retrospective analysis was performed on patients with AKI who were receiving ECMO. Patient data, including preoperative basic conditions, related clinical conditions during ECMO, and complications, were collected. The patients were divided into two groups according to the occurrence of AKI. For the determination of the ECMO-independent risk factors of AKI, risk factors that may affect AKI and those that affected AKI were selected through single-factor analysis and logistic regression analysis, respectively. Of the 170 cases included in this study, 91 had AKI (53.5%) as indicated by the single-factor analysis results. CPR before ECMO, high lactic acid levels before ECMO, high inotropic equivalents, large amounts of red blood cells, plasma and platelet transfusion, high C-reactive protein levels, high brain natriuretic peptide levels during ECMO, and a long period of ECMO support were all associated with AKI patients. Multiple-factor analysis results revealed that high lactic acid levels before ECMO (OR 2.96, 95% CI (1.38, 6.34); p=0.005) and high inotropic equivalents during ECMO (OR 3.17, 95% CI (1.52, 6.61); p=0.002) were independent risk factors of AKI in patients with ECMO. A high incidence of AKI was observed in patients with ECMO, and large doses of positive inotropic drugs and high lactic acid levels were independent risk factors of the disease in patients with ECMO. .

Towards a multi‐marker prognostic strategy in acute heart failure: a role for GDF‐15

AimsGrowth differentiation factor (GDF)‐15 mirrors inflammation and oxidative stress in cardiovascular diseases. Brain natriuretic peptide (BNP) is associated with cardiomyocyte stretch in heart failure (HF). The objective of this study was to evaluate the prognostic impact of plasma GDF‐15 and BNP in acute HF.Methods and resultsWe studied a subgroup of patients prospectively recruited in an acute HF registry (follow‐up: 2 years; endpoint: all‐cause mortality). Cox regression multivariate models were built to study the association of GDF‐15 and mortality. Further cross‐classification according to discharge GDF‐15 (mean) and BNP (mean) and association with mortality was studied. We studied 158 patients: seventy‐nine were male, mean age was 75 years, 55.1% had left ventricular ejection fraction < 40%, mean discharge BNP was 1000 pg/mL, and mean GDF‐15 was 3013 ng/mL. Higher BNP and GDF‐15 predicted 2‐year mortality. Patients with GDF‐15 ≥ 3000 ng/mL had a multivariate adjusted 2‐year death risk of 1.86 (1.08–3.18). Patients discharged with both BNP and GDF‐15 above the mean had an adjusted hazard ratio of 4.33 (2.07–9.06) when compared with those with both <mean.ConclusionsHigher GDF‐15 associated with worse prognosis in acute HF independently of BNP. When both biomarkers GDF‐15 and BNP were elevated at discharge, the 2‐year mortality risk increased over four‐fold. Biomarkers related to different pathophysiological pathways can provide incremental prognostic information in acute HF.

Brain Natriuretic Peptide Helps Prognosticate Improvement in Renal Function in Acute Heart Failure

Introduction We aimed to evaluate the prognostic implications of improved renal function (IRF) in acute heart failure (AHF) and the relationship with regards to measures of congestion. Hypothesis: AHF patients with IRF experience worse outcomes than those with no change or worsening in renal function, but this may be from insufficient decongestion. Methods The Acute Kidney Injury NGAL Evaluation of Symptomatic heart faIlure Study (AKINESIS) was a prospective, international, multicenter study of AHF patients. We investigated the relationship between IRF, changes in brain natriuretic peptide (BNP) and one-year mortality. IRF was defined as a decrease in creatinine of > 0.3 mg/dl at any time during hospitalization. BNP decrease was defined as ≥ 30% decrease in the last measured BNP compared to admission. Results Among 760 patients investigated, 95 patients (13%) experienced IRF. Patients with IRF had worse renal function and higher BNP on admission compared to those without IRF (creatinine, 2.04 mg/dl [1.60, 2.52 mg/dl] vs. 1.16 mg/dl [0.90, 1.44 mg/dl], p = 0.004; BNP, 846 ng/l [319, 1465 ng/l] vs. 535 ng/l [232, 1059 ng/l], p = 0.006). Both groups had a significant decrease in BNP ( Figure 1 ), though patients with IRF were less likely to experience a ≥ 30% BNP decrease (37% vs. 55%, p = 0.001). Discharge BNP levels were also higher in those with IRF (664 ng/l [265, 1012 ng/l] vs. 308 ng/l [128, 714 ng/l], p Figure 2 ), though after adjusting for confounders, BNP decrease but not IRF was associated with worse outcomes (IRF, adjusted HR 1.29, 95% CI 0.82-2.02, p = 0.269; BNP decrease, adjusted HR 0.61, 95% CI 0.42-0.89, p = 0.010). Conclusions IRF was associated with severe congestion on admission, insufficient decongestion during hospitalization, and residual congestion at discharge. Decongestion but not IRF was an independent predictor of worse outcomes.

Ventricular wall stress and silent myocardial damage are associated with pulse pressure in the general population.

Pulse pressure (PP) is a risk factor for cardiovascular diseases and is associated with increased afterload and myocardial oxygen demand. Brain natriuretic peptide (BNP) and heart-type fatty acid-binding protein (H-FABP) are known as biomarkers indicating ventricular wall stress and silent myocardial damage. However, the association between PP and ventricular wall stress and silent myocardial damage in the general population is unclear. The authors enrolled 3504 patients who participated in a community-based annual health check. Serum levels of BNP and H-FABP were measured as markers of ventricular wall stress and silent myocardial damage. Patients were divided into four groups according to the quartiles of PP. Patients in the highest PP group showed higher serum BNP and H-FABP levels than that of the other groups. Multivariate logistic analysis showed that high PP was independently associated with ventricular wall stress and silent myocardial damage on the basis of BNP and H-FABP levels. Compared with systolic blood pressure, diastolic blood pressure, and mean blood pressure, PP was superior in predicting ventricular wall stress and silent myocardial damage evaluated according to BNP and H-FABP levels, which was reflected by the receiver operating characteristic analysis. Screening of healthy patients revealed that high PP was related to high BNP and H-FABP levels, suggesting that an asymptomatic general population with high PP may be exposed to ventricular wall stress and myocardial damage and might be susceptible to silent heart failure.

Lack of a Tricuspid Regurgitation Doppler Signal and Pulmonary Hypertension by Invasive Measurement.

BackgroundTransthoracic echocardiography (TTE) is used to estimate pulmonary artery systolic pressure, but an adequate tricuspid regurgitation velocity (TRV) needed to calculate pulmonary artery systolic pressure is not always present. It is unknown whether the absence of a measurable TRV signifies normal pulmonary artery pressure.Methods and ResultsWe extracted hemodynamic, TTE, and clinical data from Vanderbilt's deidentified electronic medical record in all patients referred for right heart catheterization between 1998 and 2014. Pulmonary hypertension (PH) was defined as mean pulmonary artery pressure ≥25 mm Hg. We examined the prevalence and clinical correlates of PH in patients without a reported TRV. We identified 1262 patients with a TTE within 2 days of right heart catheterization. In total, 803/1262 (64%) had a reported TRV, whereas 459 (36%) had no reported TRV. Invasively confirmed PH was present in 47% of patients without a reported TRV versus 68% in those with a reported TRV (P<0.001). Absence of a TRV yielded a negative predictive value for excluding PH of 53%. Right ventricular dysfunction, left atrial dimension, elevated body mass index, higher brain natriuretic peptide, diabetes mellitus, and heart failure were independently associated with PH among patients without a reported TRV.Conclusions PH is present in almost half of patients without a measurable TRV who are referred for both TTE and right heart catheterization. Clinical and echocardiographic features of left heart disease are associated with invasively confirmed PH in subjects without a reported TRV. Clinicians should use caution when making assumptions about PH status in the absence of a measurable TRV on TTE.

Dilated cardiomyopathy with re-worsening left ventricular ejection fraction.

Re-worsening left ventricular ejection fraction (LVEF) is observed in some patients with dilated cardiomyopathy (DCM) despite initial improvements in LVEF. We analyzed cardiac outcomes and clinical variables associated with this re-worsening LVEF. A total of 180 newly diagnosed DCM patients who received only pharmacotherapy were enrolled. Echocardiography was performed after 6, 12, 24, and 36months after initiation of pharmacotherapy. Patients were divided into three groups: (1) Improved: (n = 113, 63%), defined as those > 10% increase in LVEF after 12months and no decrease (> 10%) between 12 and 36months; (2) Re-worse: (n = 12, 7%), those with > 10% increase in LVEF after 12months but with decrease (> 10%) between 12 and 36months; and (3) Not-improved: (n = 55: 30%), those with no increase in LVEF (> 10%) after 12months. Patients with re-worse group were older (P = 0.04) and had higher brain natriuretic peptide (BNP) levels after 12months (P = 0.002) than those in the Improved group. Major cardiac events (sudden death, implantation of a ventricular assist device, and death due to heart failure,) were observed in 13 (7%) patients after 36months of pharmacotherapy. Multivariate analysis revealed that the Re-worse group had a higher risk for cardiac events (hazard ratio 11.7, 95% confidence interval 1.9-90.7, P = 0.01) than the Improved group, but had a similar risk compared with the Not-improved group. Re-worsening LVEF was associated with poor cardiac outcomes in newly diagnosed DCM patients. Age and persistently high-BNP levels after improvement in LVEF were significantly associated with re-worsening LVEF.

The efficacy of serum brain natriuretic peptide for the early detection of portopulmonary hypertension in biliary atresia patients before liver transplantation.

Severe portopulmonary hypertension (POPH) is a contraindication for liver transplantation (LT) because of the high risk of postoperative heart failure. The early detection of POPH is important for patients with biliary atresia (BA). Brain natriuretic peptide (BNP) is known to be correlated with liver fibrosis in patients with liver cirrhosis. The aim of this study was to elucidate the efficacy of BNP measurement for the follow-up of patients with BA. Thirty-two patients with BA were identified from September 2011 to December 2016. As indices of liver fibrosis/cirrhosis, APRI (P<.0001), FIB-4 (P<.0001), Child-Pugh score (P<.0001), IV collagen (P=.0005), and hyaluronic acid (P=.0291) had high or moderate correlations with BNP. Patients with splenomegaly, esophageal varices, liver fibrosis, and collateral veins had significantly higher BNP levels than those without. Patients diagnosed with POPH had significantly higher BNP levels in comparison with those patients without (P=.0068). In contrast, PELD/MELD scores showed an almost negligible correlation with the BNP level. LT was successful in 3 asymptomatic BA patients with POPH who had high BNP levels despite the low PELD/MELD scores. In conclusion, routine serum BNP surveillance can be easy to predict asymptomatic POPH. This may help to identify POPH before it reaches a stage that would contraindicate LT.

Predictors of poor outcome in patients with pulmonary arterial hypertension: A single center study.

ObjectivesPulmonary arterial hypertension (PAH) is a rare disorder with unfavorable prognosis despite implementation of specific PAH-oriented therapy. The aim of the study was to define predictors of poor prognosis in patients from one center treated according to the Polish National Health Fund program.Patients and methodsForty-seven consecutive patients (30 women; aged 39±17 years) with PAH diagnosis were enrolled to the study. Clinical assessment, laboratory measurements, electrocardiogram, echocardiography, 6-minute walk test, 24-hour Holter monitoring, cardiopulmonary exercise test and microvolt T-wave alternans test were performed during routine visits. Eight patients died during 2.6±1.7 years follow-up.ResultsParametrs which differentiated patients who died were brain natriuretic peptide (BNP) concentration ≥330 pg/mL (sensitivity 88%, specificity 92%, area under the ROC curve [AUC] 0.92); bilirubin concentration ≥1.2 mg/dL (sensitivity 88%, specificity 81%, AUC 0.85); right atrial area ≥21 cm2 (sensitivity 86%, specificity 69%, AUC 0.84), right ventricular (RV) dimension in the apical 4-chamber view ≥47 mm (sensitivity 86%, specificity 86%, AUC 0.85) and RV to left ventricular diastolic diameter ratio ≥1.5 (sensitivity 83%, specificity 84%; AUC 0.85). In multivariate analysis, independent predictors of mortality were higher BNP (p = 0.04) and bilirubin level (p = 0.03), higher right atrial area (p = 0.02) and lower tricuspid annular plane systolic excursion (p = 0.03).ConclusionsIn PAH patients treated with specific PAH-oriented therapy right atrial enlargement, impaired right ventricular systolic function, as well as increased BNP and bilirubin concentration was associated with an increased mortality risk.

Do plasma neprilysin activity and plasma neprilysin concentration predict cardiac events in chronic kidney disease patients?

Since the introduction of sacubitril/valsartan in clinical cardiology, neprilysin has become a major target for heart failure treatment. Plasma neprilysin concentration has been discussed as a novel biomarker that predicts cardiac events. Natriuretic peptides may inhibit plasma neprilysin. As they accumulate in chronic kidney disease (CKD), we hypothesized that high plasma neprilysin loses its predictive role in CKD patients. We measured plasma levels of neprilysin concentration, neprilysin activity and brain natriuretic peptide (BNP) in 542 CKD G2-G4 patients within the CARE FOR HOMe study. Patients were followed for predefined endpoints of hospitalization for acute decompensated heart failure and incident atherosclerotic cardiovascular events. During 5.1 ± 2.1 years, 63 patients had acute decompensated heart failure and 125 patients had incident atherosclerotic cardiovascular events. In both Kaplan-Meier and multivariate Cox regression analyses, high plasma BNP and low, rather than elevated, neprilysin activity predicted future hospitalization for acute decompensated heart failure; neprilysin concentration was not predictive. Furthermore, only BNP was an independent predictor of incident atherosclerotic cardiovascular events. In line with experimental studies, high natriuretic peptides may inhibit neprilysin activity in CKD. Therefore, high neprilysin activity and concentrations are not predictors of adverse cardiovascular outcome in CKD patients. Thus neprilysin inhibitors should be implemented with caution in patients with advanced CKD.

Risk factors of atrial fibrillation in critical ill patients

To observe the clinical features of atrial fibrillation (AF) patients, and to explore the correlation between the routine detection index and the new-onset AF and to find out risk factors for new AF in critically ill patients. A prospective observational study was conducted. The patients with AF admitted to intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from March 2016 to June 2017 were enrolled. The patients were divided into new-onset AF group and past-existed AF group according to their past history of AF (including persistent AF, paroxysmal AF or permanent AF). In addition, patients in ICU without history of AF and new-onset AF were selected as the control group (no AF group). The general epidemiological characteristics of patients in three groups, and the blood biochemical, coagulation and other related indicators at the time of AF occurred (new-onset AF group) or 48 hours after ICU admission (AF group and no AF group) were analyzed; the difference of laboratory indexes between patients in new-onset AF group with AF within 48 hours before occurred and patients in no AF group within 48 hours after admission to ICU was compared. The relationship between each index and new-onset AF were analyzed. Pearson or Spearman rank correlation was used for analysis. Risk factors of new-onset AF were analyzed by Logistic regression analysis. 1 673 patients were admitted to ICU, including 179 cases of AF (10.70%), and 106 males and 73 females, with an average age of (71.73±23.22) years. There was 75 new-onset AF (morbidity 4.48%), and had a 28-day mortality of 45.33% (34/75). There were differences in age, previous heart disease and heart failure (HF) among new-onset AF group (n = 75), past-existed AF group (n = 104) and no AF group (n = 75). Compared with other two groups, renal insufficiency rates, troponin, serum sodium, calcium and procalcitonin levels were higher, mechanical ventilation time and the length of ICU stay were significantly prolonged, ICU and hospitalization costs were higher in new-onset AF group. Compared with no AF group, new-onset AF patients with the higher percentage of septic shock, the accumulation of vascular contraction drugs within 24 hours after AF usage were higher, and used more anti-arrhythmic drugs, has higher brain natriuretic peptide (pro-BNP), serum creatinine, blood lactic acid levels, and lower albumin, oxygenation index, and serum potassium levels, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score and 28-day mortality were higher. Correlation analysis showed that age, APACHE II score, septic shock, HF, cardiovascular disease, renal insufficiency were positively correlated with new-onset AF (r values were 0.393, 0.270, 0.386, 0.251, 0.194, 0.170; P values were 0.000, 0.001, 0.000, 0.002, 0.017, 0.037, respectively). The age [odds ratio (OR) = 0.962, P = 0.046], basic oxygenation index (OR = 1.005, P = 0.028) and serum potassium levels (OR = 1.638, P = 0.022) were the risk factors for new-onset AF. Critical patients with a high incidence of AF, new-onset AF significantly prolong the length of ICU stay; age, APACHE II score, septic shock, cardiovascular disease, and renal insufficiency are related to new-onset AF; age, basic oxygenation index and serum potassium levels are risk factors for new-onset AF.

Baseline and Serial Brain Natriuretic Peptide Level Predicts 5-Year Overall Survival in Patients With Pulmonary Arterial Hypertension: Data From the REVEAL Registry

Plasma brain natriuretic peptide (BNP) level is a prognostic biomarker in pulmonary arterial hypertension (PAH). Its impact on long-term overall survival (OS) was investigated in the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL), a 5-year observational, multicenter, US registry of patients with PAH. Patients were≥ 18 years of age, met right heart catheterization criteria at rest, had World Health Organization group I PAH, and had BNP measurement at enrollment. Optimal BNP threshold was obtained via receiver operating characteristic curve analysis. OS was compared in patients with low (≤ 340 pg/mL) vshigh (> 340 pg/mL) BNP at baseline; changes between baseline and last assessment were also examined. Patients were categorized based on baseline (low or high) and follow-up (low or high) BNP values; hazard ratios (HRs) for OS were estimated and compared using Cox regression. Overall, 1,426 patients were analyzed. Mortality risk was significantly higher in patients with baseline high vslow BNP (HR, 3.6; 95%CI, 3.0-4.2). BNP change analysis at≤ 1 year postenrollment demonstrated that the low-low group had the lowest and the high-high group had the highest 5-year mortality risk (HR, 0.23; 95%CI, 0.19-0.27). Changes in BNP score also correlated with change of risk of death. Baseline BNP threshold of 340 pg/mL strongly predicted survival up to 5 years in patients with PAH. A BNP reduction at 1 year since enrollment was associated with decreased mortality risk, whereas an increase in BNP at 1 year was associated with an increased mortality risk, supporting BNP as a surrogate marker of PAH survival.