Increased Levels Of NT-proBNP Research Articles

Correlation between carotid intima-media thickness and patient outcomes in coronary artery disease in central South Africa.

Carotid intima-medial thickness (CIMT) is a non-invasive tool used to detect atherosclerosis and diagnose cardiovascular disease. This study aimed to determine whether pre-operative CIMT measurements correlated with intra- and postoperative outcomes in patients with acute coronary syndrome (ACS) undergoing coronary artery bypass graft (CABG) surgery. This retrospective, analytical cohort included 89 patients diagnosed with ACS who received CABG surgery. Patients were divided into two cohorts: group 1: normal CIMT < 0.07 cm and group 2: abnormal CIMT ≥ 0.07 cm. B-mode ultrasound was used to measure the CIMT in all patients. Pre-, intra- and postoperative data and complications were recorded for each patient. The study included 77 (86.5%) males and 12 (13.5%) females. Pre-operative mean body mass index was significantly higher (p = 0.03) in group 2 than in group 1. Group 2 had a significantly increased incidence of diabetes (p = 0.008) and hypertension (p = 0.009), and increased NT-proBNP levels (p = 0.02). Intra- and postoperative outcomes between the groups were comparable, with no significant differences. The study showed no correlation between abnormal CIMT and increased adverse intra- and postoperative patient outcomes. Therefore, the results of this study show CIMT should not be considered a tool to predict adverse events in patients undergoing CABG surgery.

Value of left ventricular longitudinal strain in predicting overt heart failure in patients with Chagas disease and preserved left ventricular ejection fraction

Abstract Introduction Speckle-tracking echocardiography (STE) is an established tool to detect early myocardial contractile impairment. In Chagas disease patients, STE may be helpful to identify subtle myocardial damage with the potential of progression to heart failure. Purpose This study aimed to assess the value of STE in predicting heart failure in Chagas disease patients with preserved left ventricular ejection fraction (LVEF). Methods Patients with Chagas disease living in endemic area who had preserved LVEF (&amp;gt;50%) were selected for the study. Clinical evaluation, B-type natriuretic peptide (NT-ProBNP), electrocardiogram (ECG), and echocardiogram were performed at enrollment in 2015 to 2016 and in the follow-up visit between 2018 and 2019. Global longitudinal strain (GLS) derived from STE was analyzed offline. Peak GLS was calculated as the mean value from 18 segments of the left ventricle (Figure 1). The outcome was development of heart failure defined by elevation of NT-ProBNP levels, categorized according to age-specific cut-points for heart failure at the second evaluation. Patients with abnormal NT-ProBNP at baseline or those who died between the 2 visits were not included. Results A total of 692 were enrolled, mean age was 58 ± 12 years and 495 (72%) were women. Mean LVEF at baseline and follow-up visits were 63.4 ± 4.6% and 59.8 ± 11.2% (p&amp;lt;0.001). The median [IQR] time between visit 1 and visit 2 was 5.4 [4.5 - 5.8] years. Among patients alive and attending the second visit, 48 patients (7%) developed overt heart failure with overall incidence rate of 14.1 events per 1000 patient-years (95% CI 10.4-18.6). On multivariable analysis, independent predictors of new-onset heart failure were male sex (OR 2.30, 95% CI 1.02-5.18), age (OR 1.04, 95% CI 1.01-1.07), QRS duration (OR 1.03, 95% CI 1.01-1.04), left atrial (LA) volume indexed (OR 1.05, 95% CI 1.01-1.09), and GLS (OR 0.90, 95% CI 0.81-0.98). LVEF did not remain in the model. The C-statistic of the final model was 0.80 (95% CI 71-88) showing a good discrimination. Conclusions In a cohort of patients with Chagas disease from remote areas with preserved ejection fraction, GLS was an important predictor of progression to overt heart failure, after adjustment for sex, age, QRS duration and LA volume. GLS was associated with further increased NT-ProBNP levels, which is useful to guide heart failure management, irrespective of systolic dysfunction.

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

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

N-Terminal pro-Brain Natriuretic Peptide is a biomarker for cardiovascular damage in systemic lupus erythematous: a cross-sectional study.

Prediction models based on traditional risk factors underestimate cardiovascular (CV) risk in systemic lupus erythematosus (SLE). In a large sample of unselected SLE patients, we investigated cross-sectional associations of NT-proBNP with cardiovascular damage (CVD). Serum NT-proBNP was measured in SLE patients enrolled in the MUHC Lupus Clinic registry. Serum were collected between March 2022 and April 2023 at annual research visits. The primary outcome was CVD identified on the SLICC Damage Index. Factors associated with CVD and NT-proBNP levels were determined. Overall, 270 SLE patients (female 91%, median age 50.7 [1st quartile- 3rd quartile : 39.6-62.1] years) were analyzed for the primary outcome. Among them, 33 (12%) had CVD. The ROC curve for NT-proBNP demonstrated strong associations with CVD (AUC 0.78, 95% CI 0.69-0.87) with a threshold of 133 pg/ml providing the best discrimination for those with/without CVD. Hypertension (OR 3.3, 95% CI 1.2-9.0), dyslipidaemia (OR 3.6, 95% CI 1.3-9.6) and NT-proBNP > 133 pg/ml (OR 7.0, 95% CI, 2.6-19.1) were associated with CVD in the multivariable logistic regression model. Increased NT-proBNP levels were associated with age (OR 4.2, 95% CI 2.2-8.3), ever smoking (OR 1.9, 95% CI 1.0-3.5), reduced eGFR (4.1, 95% CI 1.3-13.1), prior pericarditis/pleuritis (OR 2.5, 95% CI 1.4-4.5) and aPL antibodies (OR 2.6, 95% CI 1.4-4.9). NT-proBNP is a biomarker for CV damage in SLE. The novel associations of NT-proBNP levels with prior pericarditis/pleuritis and aPL antibodies suggest new avenues for research to better understand what drives CV risk in SLE.

Опыт лечения сердечной недостаточности как проявления кардиотоксичности химиотерапии у онкологических пациентов

Aim. To evaluate the effectiveness of morpholinium-methyl-triazolyl-thioacetate (thiotriazoline) in the treatment of heart failure as manifestations of cardiotoxicity of chemotherapy in patients with lymphomas. Material and methods. 54 patients with lymphomas were examined against the background of course antitumor therapy. All patients underwent a standard examination (physical examination, laboratory tests, including Nt-proBNP, troponin I, electrocardiogram, echocardiography). In case of detection of symptoms of heart failure (n = 21), thiotriazoline was administered intravenously with further transition to tablet form. Results. Signs of heart failure (shortness of breath, edema, positive water balance, increased Nt-proBNP levels) were recorded in 35 (64.8%) patients. According to the results of the control echocardiography, no significant changes in cardiac hemodynamics were detected. Daily assessment of hemodynamic parameters with an assessment of the severity of dyspnea and edema, allowed to verify the initial manifestations of cardiotoxicity by laboratory methods at the initial stages. The use of thiotriazoline allowed to normalize the level of Nt-proBNP and prevent further deterioration of the clinical picture of HF. Conclusion. The use of thiotriazoline makes it possible to prevent and slow down the processes of the cardiovascular continuum, leading to the occurrence of heart failure or decompensation of existing HF in patients receiving treatment for oncological diseases.

Increased NT-proBNP levels and cardiac ventricular function during aortic valve replacement (pilot study)

The objective was to study the relationship between the increased preoperative N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) blood levels and the parameters of the heart ventricles function, as well as the conditions for coronary perfusion of their myocardium before and after on-pump aortic valve replacement.Materials and methods. The study involved 27 patients aged 57.7±2.5 years who underwent aortic valve replacement. NT-proBNP blood level was determined before surgery. The level of NT-proBNP &gt; 1000 pg/ml was considered increased. Invasive hemodynamics, including the data of the right ventricle thermodilution volumetry, and transesophageal echocardiography data were analyzed at the stages: the 1st – after anesthesia induction, the 2nd – at the end of surgery. Logistic regression and ROC analysis were used for data processing.Results. Preoperative blood levels of NT-proBNP &gt; 1000 (3163.0[2507.25–7319]) pg/ml were recorded in 55.6% of patients. At the 1st stage, the biomarker increased level was associated with increased index of left ventricular end-systolic volume (OR 1.0955, 95% CI 1.0097–1.1885, p = 0.028, AUC 0.903), decreased left ventricular ejection fraction (OR 0, 9447, 95% CI 0.8949–0.9973, p = 0.040, AUC 0.753) and area contraction fraction (OR 0.8868, 95% CI 0.8086–0.9726, p = 0.011, AUC 0.890), increased mean pulmonary artery pressure (OR 1.1824, 95% CI 1.0020–1.3952, p = 0.047, AUC 0.722), and increased transpulmonary gradient (OR 1.4497, 95% CI 1.0103–2.0802, p = 0.044, AUC 0.810), increased right ventricular stroke work index (OR 1.5151, 95% CI 1.0319–2.2246, p = 0.034, AUC 0.761), and decreased coronary perfusion gradients of the left (OR 0.8961–0.9241, 95% CI 0.8229–0.9459 – 0.8630–0.9896, p = 0.012–0.024, AUC 0.793–0.861) and right (OR 0.9519, 95% CI 0.9136–0.9918, p = 0.019, AUC 0.847) ventricles. At the 2nd stage, NT-proBNP blood values &gt; 1000 pg/ml were associated with impaired left ventricular function, decreased mean arterial pressure (OR 0.9066, 95% CI 0.8264–0.9946, p = 0.038, AUC 0.761), and the vasopressor and inotropic support (OR 8.4000, 95% CI 1.2584–56.0694, p = 0.028, AUC 0.710).Conclusions. Prior to aortic valve replacement, the blood level of NT-proBNP &gt; 1000 pg/ml is associated with a moderate decrease in the left ventricular ejection fraction and area contraction fraction, an increased left ventricular end-systolic volume with a normal end-diastolic volume, an increased index of right ventricular stroke work in combination with moderately increased mean pulmonary artery pressure and increased transpulmonary gradient, as well as a decreased coronary perfusion gradients. At the end of operations, increased NT-proBNP blood level is associated with signs of impaired left ventricular contractility, a tendency to arterial hypotension, and the vasopressor and inotropic support. Increased preoperative NT-proBNP blood level are not associated with right ventricular volumes and ejection fraction both before and after on-pump aortic valve replacement.

Diseases associated with prematurity in correlation with N-terminal pro-brain natriuretic peptide levels during the early postnatal life

The aim of this observational study was to investigate the influence of different typical preterm diseases on NT-proBNP serum levels in the early postnatal period of life of a preterm infant. NT-proBNP levels of 118 preterm infants born ≤ 31 weeks GA were determined at the first week of life, after 4 ± 1 weeks of life, and at a corrected gestational age of 36 + 2 weeks. Relevant complications with a possible influence on NT-proBNP values in the first week of life such as early neonatal infection, hemodynamically significant PDA (hsPDA), early pulmonary hypertension (early PH), and intraventricular hemorrhage (IVH) were evaluated; at 4 ± 1 weeks of life, bronchopulmonary dysplasia (BPD), BPD-related pulmonary hypertension (BPD-associated PH), late infection, IVH, and intestinal complications were evaluated. At a corrected gestational age of 36 ± 2 weeks, we examined the effect of retinopathy of prematurity (ROP), BPD, BPD-associated PH, and late infection on NT-proBNP levels. In the first days of life, only the isolated occurrence of hsPDA resulted in significantly increased NT-proBNP levels. In multiple linear regression analysis, early infection remained independently associated with NT-proBNP levels. At 4 ± 1 weeks of age, the isolated presence of BPD and BPD-related PH resulted in increased levels, and the effect remained significant in the multiple regression analysis. At a corrected gestational age of 36 ± 2 weeks, infants with relevant complications at this final evaluation time tended to have lower NT-proBNP values than our exploratory reference values. Conlusion: NT-proBNP in the first week of life seems to be mainly influenced by an hsPDA and infection or inflammation. BPD and BPD-related PH are the most important factors influencing NT-proBNP serum levels in the first month of life. When preterm infants reach a corrected GA of 36 ± 2 weeks, chronological age rather than complications of prematurity must be considered when interpreting NT-proBNP levels.What is Known:• Several complications associated with prematurity, such as hemodynamically significant PDA, pulmonary hypertension, bronchopulmonary dysplasia, and retinopathy of prematurity, have been shown to influence NT-proBNP levels in preterm infants in their early postnatal life.What is New:• Hemodynamically relevant PDA is a major factor in the increase of NT-proBNP levels in the first week of life.• Bronchopulmonary dysplasia and pulmonary hypertension associated with bronchopulmonary dysplasia are important factors in the increase in NT-proBNP levels in preterm infants at approximately 1 month of age.

The value of clinical routine blood biomarkers in predicting long-term mortality after stroke.

Several blood biomarkers have been identified as predictors for poor outcome after ischemic stroke. However, recent studies mainly focused on single or experimental biomarkers and considered rather short follow-up intervals limiting their value for daily clinical practice. We, therefore, aimed to compare various clinical routine blood biomarkers for their predictive value on post-stroke mortality over a 5-year follow-up period. This data analysis of a prospective single-center study included all consecutive ischemic stroke patients admitted to the stroke unit of our university hospital over a 1-year period. Various blood biomarkers of inflammation, heart failure, metabolic disorders, and coagulation were analyzed from standardized routine blood samples collected within 24 h of hospital admission. All patients underwent a thorough diagnostic workup and were followed for 5 years post-stroke. Of 405 patients (mean age: 70.3 years), 72 deceased (17.8%) during the follow-up period. While various routine blood biomarkers were associated with post-stroke mortality in univariable analyses, only NT-proBNP remained an independent predictor (adjusted odds ratio 5.1; 95% CI 2.0-13.1; p < 0.001) for death after stroke. NT-proBNP levels ⩾794 pg/mL (n = 169, 42%) had a sensitivity of 90% for post-stroke mortality with a negative predictive value of 97% and was additionally associated with cardioembolic stroke and heart failure (each p ⩽ 0.05). NT-proBNP represents the most relevant routine blood-based biomarker for the prediction of long-term mortality after ischemic stroke. Increased NT-proBNP levels indicate a vulnerable subgroup of stroke patients in which early and thorough cardiovascular assessment and consistent follow-ups could improve outcome after stroke.

Semaglutide inhibits ischemia/reperfusion-induced cardiomyocyte apoptosis through activating PKG/PKCε/ERK1/2 pathway

Apoptosis is a major pathophysiological change following myocardial ischemia/reperfusion (I/R) injury. Glucagon-like peptide 1 (GLP-1) and its receptor GLP-1R are widely expressed in the cardiovascular system and GLP-1/GLP-1R activates the protein kinase G (PKG)-related signaling pathway. Therefore, this study tested whether semaglutide, a new GLP-1 analog, inhibits I/R injury-induced cardiomyocyte apoptosis by activating the PKG/PKCε/ERK1/2 pathway. We induced myocardial I/R injury in rats and hypoxia/reoxygenation (H/R) injury in H9C2 cells and detected the effects of semaglutide, a PKG analog (8-Br-cGMP), and a PKG inhibitor (KT-5823) on the PKG/PKCε/ERK1/2 pathway and cardiomyocyte apoptosis. We found that semaglutide upregulated GLP-1R levels, and both semaglutide and 8-Br-cGMP activated the PKG/PKCε/ERK1/2 pathway, inhibited myocardial infarction (MI), decreased hs-cTNT levels, increased NT-proBNP levels, and suppressed cardiomyocyte apoptosis in I/R rats and H/R H9C2 cells. However, KT-5823 exerted contrasting effects with semaglutide and 8-Br-cGMP, and KT-5823 weakened the cardioprotective effects of semaglutide. In conclusion, semaglutide inhibits I/R injury-induced cardiomyocyte apoptosis by activating the PKG/PKCε/ERK1/2 pathway. The beneficial effect of GLP-1/GLP-1R, involved in the activation of the PKG/PKCε/ERK1/2 pathway, may provide a novel treatment method for myocardial I/R injury.

Association of amniotic fluid natriuretic peptide levels with ductus venosus Doppler flow in recipient twins with twin-to-twin transfusion syndrome

This study examined the relationships between fetal quantitative Doppler parameters and amniotic fluid N-terminal prohormone brain natriuretic peptide (afNT-proBNP) levels as a biomarker of the increased cardiac load in recipient twins with twin-to-twin transfusion syndrome (TTTS). This single-center, prospective study included all monochorionic diamniotic (MD) twin pregnancies that were diagnosed with TTTS and underwent fetoscopic laser surgery. Doppler flow was used to measure the pulsatility index (PI) of the umbilical artery (UA), ductus venosus (DV), and middle cerebral artery (MCA) of each recipient and donor twins. The afNT-proBNP levels of recipient twins were examined at the time of surgery. The Spearman or Pearson correlation coefficients were used to assess the relationships between afNT-proBNP levels and Doppler parameters. A total of 150 MD twin pregnancies were included. The afNT-proBNP levels of the recipient twins showed a stronger correlation with the DV-PI (r = 0.637; P < 0.001) of recipient twins than with the UA-PI and MCA-PI of recipient twins. The Doppler parameters of donor twins were scarcely correlated with the afNT-proBNP levels of the recipient twins. A positive correlation between the DV-PI and afNT-proBNP levels of recipient twins with TTTS was observed. The recipient twin with an increased DV-PI is expected to be under a high cardiac load; therefore, DV-PI is a useful parameter for assessing increased NT-proBNP levels consecutively and noninvasively. This study was registered with Japanese Clinical Trial Registry "UMIN-CTR" ( http://www.umin.ac.jp/ctr/index-j.htm ; trial ID numbers UMIN000024486 and 000037702).

New insights into the potential utility of the left atrial function analysis in heart failure with preserved ejection fraction diagnosis.

AimsNone of the conventional echocardiographic parameters alone predict increased NTproBNP level and symptoms, making diagnosis of heart failure with preserved ejection fraction (HFpEF) very difficult in some cases, in resting condition. We evaluated LA functions by 2D speckle tracking echocardiography (STE) on top of conventional parameters in HFpEF and preHF patients with diastolic dysfunction (DD), in order to establish the added value of the LA deformation parameters in the diagnosis of HFpEF.MethodsWe prospectively enrolled 125 patients, 88 with HFpEF (68±9 yrs), and 37 asymptomatic with similar risk factors with DD (preHF) (61±8 yrs). We evaluated them by NTproBNP, conventional DD parameters, and STE. Global longitudinal strain (GS) was added. LA reservoir (R), conduit (C), and pump function (CT) were assessed both by volumetric and STE. 2 reservoir strain (S) derived indices were also measured, stiffness (SI) and distensibility index (DI).ResultsLA R and CT functions were significantly reduced in HFpEF compared to preHF group (all p<0.001), whereas conduit was similarly in both groups. SI was increased, whereas DI was reduced in HFpEF group (p<0.001). By adding LA strain analysis, from all echocardiographic parameters, SR_CT<-1.66/s and DI<0.57 (AUC = 0.76, p<0.001) demonstrated the highest accuracy to identify HFpEF diagnosis. However, by multivariate logistic regression, the model that best identifies HFpEF included only SR_CT, GS and sPAP (R2 = 0.506, p<0.001). Moreover, SR_CT, DI, and sPAP registered significant correlation with NTproBNP level.ConclusionsBy adding LA functional analysis, we might improve the HFpEF diagnosis accuracy, compared to present guidelines. LA pump function is the only one able to differentiates preHF from HFpEF patients at rest. A value of SR_CT < -1.66/s outperformed conventional parameters from the scoring system, reservoir strain, and LA overload indices in HFpEF diagnosis. We suggest that LA function by STE could be incorporated in the current protocol for HFpEF diagnosis at rest as a major functional criterion, in order to improve diagnostic algorithm, and also in the follow-up of patients with risk factors and DD, as a prognostic marker. Future studies are needed to validate our findings.

Intra-aortic balloon pump in patients with acute advanced heart failure. Results from a single-center study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with advanced heart failure are frequently referred to cardiac intensive care unit (CICU) for hemodynamic support. Despite optimum pharmacological therapy many of these patients persist in critical condition, demanding short term circulatory support until recovery or heart transplantation. Intra-aortic balloon pump is commonly used in patients with advanced heart failure in order to stabilize hemodynamically compromised patients as bridge to decision for further therapies. Purpose To investigate the outcomes of patients with acute advanced heart failure referred to cardiac intensive care unit and supported with short term mechanical support. To explore the hemodynamic effects of the Intra-aortic balloon pump therapy in these patients. Material &amp; Method We retrospectively analyzed the data from 104 patients with acute advanced heart failure (either as worsening of existing symptoms of chronic HF or as first onset of HF). All patients had severe left ventricular dysfunction, which was frequently associated with right ventricular dysfunction and increased NT pro BNP levels. Demographic data were collected including co-morbidities. Laboratory data included NT-pro BNP, total bilirubin, serum creatinine, urea and baseline e GFR (MDRD Formula). All patients received IABP support and underwent right heart catheterization. Measurements were made before and after the insertion of the IABP. The study has been approved by the Scientific Committee and the Ethics Committee of the Hospital. Results The mean age of the sample was 44 ± 12 years. 76 patients (73, 08%) were male. 20 patients (19, 23%) were of ischemic etiology. The median time on IABP support for the entire cohort was 13 days (3 – 41, 25). There was statistically significant decrease in the NT-pro BNP levels (p&amp;lt;0, 0001). There was improvement in renal function (e GFR (p&amp;lt;0, 0001) and urea levels (p&amp;lt; 0,001)). There was statistically significant improvement in the right heart catheterization measurements (decrease of the right atrium pressure (p &amp;lt;0, 0001), of the PA pressure (p&amp;lt;0,001), and of the pulmonary capillary wedge pressure (p&amp;lt;0,001)). IABP provided clinical stabilization in 88 patients (87, 62%), that is completed pre-transplant evaluation and proceeded in surgery with permanent mechanical support or heart transplantation or transfer to regular ward, while 16 patients (15, 38%) ended up in CICU while being on IABP. Conclusions In this single center study the use of IABP improved the laboratory findings and the hemodynamic status of patients admitted in the cardiac intensive care unit with acute advanced heart failure. It was an effective method of managing patients as bridge to decision for further therapies.

Risk Factors and Outcome Variables of Cardiorenal Syndrome Type 1 in Acute Myocardial Infarction Patients.

PurposeThis study’s goal was to explore risk factors affecting short-term prognosis of cardiorenal syndrome type 1 (CRS1) in acute myocardial infarction (AMI) patients.MethodsIn this retrospective analysis of CRS1 in AMI patients hospitalized from January 2011 to December 2014, the patients were classified into deceased or survivor groups. Clinical data, including demographics, laboratory results, and 28-day outcomes, were collected.ResultsThe incidence rate of CRS1 in AMI patients was 15.2% (274 in 1801). Ultimately, 88 patients were enrolled and 25 (28.4%) were classified into the deceased group, while 63 were classified into the survivor group. There were statistically significant differences between the groups for hypertension, mechanical ventilation, KIDGO stage, NT-proBNP, Hb, ALB, PCI, decreased LVEF, 7th-day SCr value, and the highest SCr value recorded within 7 days (all P < 0.05). Multivariate logistic regression showed that the following factors were significantly related to whether a patient died: requiring mechanical ventilation, increased NT-proBNP levels and 7th-day SCr values, and decreased LVEFs. The APACHE II, SOFA, and SASP II scores on the 7th day were significantly higher in the deceased group (all P < 0.05). The accuracy of APACHE II, SOFA, and SASP II scores on the 7th day for predicting death were 84.1%, 78.4% and 79.5%, respectively. The AUC of 7th-day APACHE II, SOFA, and SASP II scores was 0.844, 0.803, and 0.827, respectively, with no statistically significant differences between the three scores (P > 0.05).ConclusionThe mortality rate of CRS1 in AMI patients was 28.4% (25 in 88) within 28 days. Mechanical ventilation, increased NT-proBNP levels, the 7th-day SCr value, and decreased LVEF were related to death in AMI patients with CRS1. APACHE II, SOFA, and SAPS II scores on the 7th day were satisfactorily accurate in predicting death within 28 days.

IS THERE ANY INFLUENCE OF THE ANTIRHEUMATIC THERAPY ON HEART DAMAGE IN SYSTEMIC LUPUS ERYTHEMATOSUS?

TOPIC: Cardiovascular Disease TYPE: Original Investigations PURPOSE: Cardiovascular involvement in systemic lupus erythematosus (SLE) patients can be associated with disease severity, activity and treatment-related factors. The goal is to determine possible differences in the structure and frequency of heart damage in SLE patients, with and without antirheumatic therapy. METHODS: This is a prospective cross-sectional study including 87pts (91% females, aged 32[28-41]years (median[interquartile range 25%-75%]) with SLE(SLICC 2012 criteria). All patients were divided into 2 groups: the 1st group was composed of “untreated” patients and the 2nd – of patients receiving antirheumatic therapy. The 1st group included 42pts(93% females) aged 31[27–40]years who were not receiving steroids, immunosuppressants and biological agents, 4(10%) of them were on hydroxychloroquine (HCQ) therapy 200 mg/day. The 2nd group is represented by 45pts(89% females) aged 34[28-45]years. Out of them 44(98%) patients were on prednisone therapy at 10[8-15]mg/day, 9(21%)- on cyclophosphamide, 6(13%)-azathioprine, 4(8%)-mycophenolate mofetil, 4(8%)-methotrexate, 32(71%)–HCQ, and 9(19%)–on biologic (rituximab, belimumab). Patients receiving antirheumatic therapy (group 2) had longer disease duration (96 vs 18 months, p<0,00001), lower disease activity (SLEDAI-2K 4 vs 12 scores,p<0,001), higher SLICC/DI (1 vs 0 score,p<0,001); lower percentage of them had skin lesions (11 vs 57%,p<0,0001), arthritis (22 vs 52%,p<0,05) and hematological disorders (24 vs 74%,p<0,0001) than “untreated” patients from the 1st group.Serum levels of NT-proBNP were measured using electrochemiluminescence method Elecsys proBNP II(Roche Diagnostics, Switzerland). Normal NT-proBNP levels should vary within ≤125pg/ml. RESULTS: No differences in terms of pericarditis (43% and 47%) (both exudative and adhesive), endocarditis (26% and 33%), arrhythmias (19% and 18%) and cardiac conduction defect (2% each), coronary artery disease (2% and 9%), myocardial infarction (0 and 4%), and heart failure (7% and 15%) frequencies were found between the “treatment-na?v” SLE patients and patients receiving antirheumatic therapy (p>0,05 for all cases). NT-proBNP concentrations were higher in “treatment-na?v”patients (150,7 vs 32,6 pg/ml,p<0,01), exceeding normal values (>125,0pg/ml).Myocarditis diagnosed by based on clinical, laboratory and instrumental findings (without myocardial biopsy) were documented in “treatment-na?v” patients only, but difference did not reach statistical significance (10% vs 0,p=0,050).Hypertension was more common in patients from the 2ndgroup (62% and 29%,p<0,01), but no differences were found in the frequency of other traditional risk factors, although total cholesterol levels and body mass index (BMI) were higher than in 1stgroup: 5,7 vs 4,5 mmol/L,p<0,05; 22,66 and 22,10 kg/m2,p<0,01, respectively. CONCLUSIONS: Antirheumatic therapy does not seemingly aggravate the heart damage in SLE patients, yielding no statistical difference in both - variety or frequency of most common CV pathologies. But the therapy (mostly steroids) and longer disease duration is associated with hypertension, high cholesterol level and BMI. Higher disease activity (in “treatment-na?v” patients) is associated with the increased NT-proBNP level, and possibly, higher frequency of myocarditis. CLINICAL IMPLICATIONS: Antirheumatic therapy does not aggravate the heart damage in SLE DISCLOSURES: No relevant relationships by Elena Gerasimova, source=Web Response No relevant relationships by Yulia Gorbunova, source=Web Response No relevant relationships by Liubov Kondrateva, source=Web Response No relevant relationships by Tatiana Panafidina, source=Web Response No relevant relationships by Tatiana Popkova, source=Web Response

Determinants of Prolonged Length of Hospital Stay of Patients with Atrial Fibrillation.

Background and Aim: The increasing prevalence and high hospitalization rates make atrial fibrillation (AF) a significant healthcare strain. However, there are limited data regarding the length of hospital stay (LOS) of AF patients. Our purpose was to determine the main drivers of extended LOS of AF patients. Methods: All AF patients, hospitalized consecutively in a tertiary cardiology center, from January 2018 to February 2020 were included in this retrospective cohort study. Readmissions were excluded. Prolonged LOS was defined as more than seven days (the upper limit of the third quartile). Results: Our study included 949 AF patients, 52.9% females. The mean age was 72.5 ± 10.3 years. The median LOS was 4 days. A total of 28.7% had an extended LOS. Further, 82.9% patients had heart failure (HF). In multivariable analysis, the independent predictors of extended LOS were: acute coronary syndromes (ACS) (HR 4.60, 95% CI 1.66–12.69), infections (HR 2.61, 95% CI 1.44–3.23), NT-proBNP > 1986 ng/mL (HR 1.96, 95% CI 1.37–2.82), acute decompensated HF (ADHF) (HR 1.76, 95% CI 1.23–2.51), HF with reduced ejection fraction (HFrEF) (HR 1.69, 95% CI 1.15–2.47) and the HAS-BLED score (HR 1.42, 95% CI 1.14–1.78). Conclusion: ACS, ADHF, HFrEF, increased NT-proBNP levels, infections and elevated HAS-BLED were independent predictors of extended LOS, while specific clinical or therapeutical AF characteristics were not.

A Contemporary View of Natriuretic Peptides in the SARS-CoV-2 Era.

The heart releases natriuretic peptides (NPs) which represent an important hormonal axis with cardiorenal protective effects. In view of their properties, NPs have pathophysiologic, diagnostic and prognostic implications in several cardiovascular diseases (CVDs). Severe pulmonary inflammation, as induced by the SARS-COV2, may increase pulmonary pressure with potential influence on NPs release, whereby normal cardiovascular integrity becomes impaired. Moreover, pre-existing CVDs are strong negative prognostic factors since they exacerbate the effects of the viral infection and lead to worse outcomes. In this context, it may be expected that NPs exert a key protective role toward the virus infection whereas an impairment of NPs release contributes to the virus deleterious effects. In this review article we explore the potential involvement of NPs in the COVID-19 disease. To this aim, we will first focus on the interactions between NPs and the Ang II/ATIR arm of the renin-angiotensin-aldosterone system (RAAS) as well as with the protective ACE2/Ang (1-7) arm of the RAAS. Subsequently, we will review evidence that strongly supports the role of increased NT-proBNP level as a marker of cardiac damage and of worse prognosis in the COVID-19 affected patients. Finally, we will discuss the potential therapeutic benefits of these protective hormones toward the viral infection through their endothelial protective function, anti-inflammatory and anti-thrombotic effects. In conclusion, the potential implications of NPs in the SARS-CoV-2 infection, as discussed in our article, represent an important issue that deserves to be fully investigated.

Left ventricular asymmetric remodeling and subclinical left ventricular dysfunction in patients with calcific aortic valve stenosis – Results from a subanalysis of the PROGRESSA study

BackgroundLV asymmetric remodeling (LVAR) is a feature commonly found in AS patients and it is presumed to be mainly related to the severity of valve stenosis. The aim of this study was to determine the associated factors and impact on left ventricular (LV) systolic function of LVAR in patients with mild and moderate aortic valve stenosis (AS). MethodsClinical, Doppler-echocardiographic and computed-tomographic data of 155 AS patients with preserved LV ejection fraction (≥50%) prospectively recruited in the PROGRESSA study (NCT01679431) were analyzed. LVAR was defined as a septal wall thickness ≥ 13 mm and a ratio of septal/posterior wall thickness > 1.5. LV global longitudinal strain (LV-GLS) was available in 129 patients. Plasma levels of N-terminal natriuretic B-type peptides (Nt-proBNP) were also measured. ResultsMean age was 63 ± 15 years (70% men). LVAR was present in 21% (n = 33) of patients. A series of nested multivariate analysis revealed that age was the only factor associated with LVAR (all p ≤ 0.03). Additionally, these patients had higher baseline Nt-proBNP ratio (median [25–75 percentiles]: 1.04 [0.66–2.41] vs. 0.65 [0.33–1.19], p = 0.02), and significantly reduced LV-GLS (17.9[16.6–19.5] vs. 19.3[17.4–20.7] |%|, p = 0.04). A 1:1 matched analysis showed a significant association of LVAR with reduced LV-GLS (17.9[16.6–19.5] vs. 19.8[18.1–20.7] |%|, p = 0.02) and elevated Nt-proBNP (134[86–348] vs. 83[50–179]pg/ml, p = 0.03). Multivariable analysis also revealed that LVAR remains significantly associated with reduced LV-GLS (p = 0.03) and elevated Nt-proBNP (p = 0.001). LVAR was significantly associated with increased risk of major adverse cardiac events and death (Hazard ratio [95% confidence interval]: 2.32[1.28–4.22], p = 0.006). ConclusionsLVAR was found in ~20% of patients with mild or moderate AS and was not related to the degree of AS severity or concomitant comorbidities, but rather to older age. LVAR was significantly associated with reduced LV longitudinal systolic function, increased Nt-proBNP levels, and higher risk of major adverse events and death. These findings provide support for closer clinical and echocardiographic surveillance of patients harboring this adverse LV remodeling feature.

Asymptomatic severe aortic stenosis: what is the current role of exercise stress test and NT-proBNP in patient risk stratification

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Aortic stenosis (AS) is prevalent in the elderly population. When severe and the patient is symptomatic or left ventricular dysfunction arises, the prognosis deteriorates and valve replacement (AVR) is recommended. During the asymptomatic phase regular clinical evaluation is advised to detect early onset of symptoms and/or signs of myocardial maladaptation. Due to the inherent difficulties in the evaluation of symptoms, especially in the elderly, as well as the change in prognosis when symptoms appear (even if not perceived), it is crucial to evaluate the behavior of patients with effort and signs of myocardial injury. Methods An observational and retrospective study that included 74 patients followed at the Cardiology Service by severe AS (aortic valve area ≤ 1cm2 and/or aortic transvalvular mean gradient ≥40mmHg), who underwent exercise stress test (EST) and NT-proBNP evaluation for risk stratification. The outcome studied was hospitalization for heart failure (HF), or referral to SV, or death during the follow-up period. Independent predictors were obtained using multivariate Cox regression. Results Non-progression or decrease in systolic blood pressure (SBP) in EST is the only independent predictor of a short-term adverse event (p = 0.025). This parameter, NT-proBNP levels and interventricular septal thickness (IVS) were independent predictors of a medium (two (p = 0.025; p = 0.014; p = &amp;lt;0.001), three (p = 0.015; p = 0.007; p = 0.001) and four years (p = 0.007; p = 0.049; p = 0.005)) and a long term adverse event (p = 0.006; p = 0.028; p = 0.005). Conclusion In asymptomatic patients with severe AS, no progression or decrease in SBP in EST, increased NT-proBNP levels and thickness of IVS were independent predictors of hospitalization for HF, need for VS or death in short, medium and long term.

Factors Associated with Duration of Hospitalization in Patients with COVID-19

Background and Objective: Coronavirus disease 2019 (COVID-19) has caused a large number of casualties and economic losses. Reducing the number of hospitalization days can alleviate pressure on health services and save more people. This study was carried out to find associated factors with the duration of hospitalization at a COVID-19 dedicated hospital in China. Methods: In this retrospective study, the demographic details and laboratory tests of 556 patients were collected. These patients were cured and discharged. The data was analyzed using statistical package for the social sciences (SPSS), version 22. The Shapiro-Wilk method was used for the normality of data with P ≤ 0.05 as significant to relate factors with the duration of hospitalization. Results: A total of 556 patients with COVID-19 were included in the study; 249 were males and 307 were females. Among the factors associated with longer hospital stay, lower K+ and Na+ levels were noticed in 102 (18.5%) and 61 (11%) respectively. Among liver functions tests, elevated AST levels was found in 109 (19.6%) patients, decreased serum albumin seen in 301 (54.1%) patients, elevated serum ALT levels in 80 (14.3%) patients with longer hospital stay (P = 0.032). Increased procalcitonin (PCT) was noticed in 66 (11.8%) patients. An elevated level of plasma D-dimer was seen in 125(22.4%) and increased NT-pro BNP levels in 64 (11.5%) patients. Increased cTnT levels were found in 76(13.6%) patients and elevated creatinine levels in 114 (21%) patients.(P = 0.015). Conclusion: Patients with elevated serum total cholesterol had significantly lesser hospital stay than the normal group. Patients with temperature ≥ 38°C and elevated blood glucose had longer hospitalization stay. We recommend that health care providers should not ignore multiple organ support when treating patients.

Factors Associated with Duration of Hospitalization in Patients with COVID-19

&lt;p&gt;Background and Objective: &amp;nbsp;Coronavirus disease 2019 (COVID-19) has caused a large number of casualties and economic losses. Reducing the number of hospitalization days can alleviate pressure on health services and save more people. This study was carried out to find associated factors with the duration of hospitalization at a COVID-19 dedicated hospital in China.&lt;/p&gt;&#x0D; &lt;p&gt;Methods: &amp;nbsp;In this retrospective study, the demographic details and laboratory tests of 556 patients were collected. These patients were cured and discharged. The data was analyzed using statistical package for the social sciences (SPSS), version 22. The Shapiro-Wilk method was used for the normality of data with P &amp;le; 0.05 as significant to relate factors with the duration of hospitalization.&lt;/p&gt;&#x0D; &lt;p&gt;Results: &amp;nbsp;A total of 556 patients with COVID-19 were included in the study; 249 were males and 307 were females. Among the factors associated with longer hospital stay, lower K+ and Na+ levels were noticed in 102 (18.5%) and 61 (11%) respectively. Among liver functions tests, elevated AST levels was found in 109 (19.6%) patients, decreased serum albumin seen in 301 (54.1%) patients, elevated serum ALT levels in 80 (14.3%) patients with longer hospital stay (P = 0.032). Increased procalcitonin (PCT) was noticed in 66 (11.8%) patients. An elevated level of plasma D-dimer was seen in 125(22.4%) and increased NT-pro BNP levels in 64 (11.5%) patients. Increased cTnT levels were found in 76(13.6%) patients and elevated creatinine levels in 114 (21%) patients.(P = 0.015).&lt;/p&gt;&#x0D; &lt;p&gt;Conclusion: &amp;nbsp;Patients with elevated serum total cholesterol had significantly lesser hospital stay than the normal group. Patients with temperature &amp;ge; 38&amp;deg;C and elevated blood glucose had longer hospitalization stay. We recommend that health care providers should not ignore multiple organ support when treating patients.&lt;/p&gt;