Log-transformed B-type Natriuretic Peptide Research Articles

A new staging system using right atrial strain in patients with immunoglobulin light-chain cardiac amyloidosis.

There are minimal data on the prognostic impact of right atrial strain during the reservoir phase (RASr) in patients with immunoglobulin light-chain (AL) cardiac amyloidosis. Among 78 patients who were diagnosed with AL cardiac amyloidosis at Kumamoto University Hospital from 2007 to 2022, 72 patients with sufficient two-dimensional speckle tracking imaging data without chemotherapy before the diagnosis were retrospectively analysed. During a median follow-up of 403days, 31 deaths occurred. Age and the rate of male sex were not significantly different between the all-cause death group and the survival group (age, 70.4±8.8years vs. 67.0±10.0years, P=0.14, male sex, 65% vs. 66%, P=0.91). The estimated glomerular filtration rate (eGFR) was significantly lower, and B-type natriuretic peptide (BNP) and high sensitivity cardiac troponin T (hs-cTnT) were significantly higher, in the all-cause death group versus the survival group (eGFR, 48.2±21.0mL/min/1.73m2 vs. 59.4±24.4mL/min/1.73m2, P<0.05, BNP, 725 [360-1312] pg/mL vs. 123 [81-310] pg/mL, P<0.01, hs-cTnT, 0.12 [0.07-0.18] ng/mL vs. 0.05 [0.03-0.08] ng/mL, P<0.01). Left ventricular (LV) global longitudinal strain (GLS) (LV-GLS), left atrial strain during the reservoir phase (LASr), right ventricular GLS (RV-GLS), and RASr were significantly lower in the all-cause death group versus the survival group (LV-GLS, 8.5±4.3% vs. 11.8±3.8%, P<0.01, LASr, 8.8±7.1% vs. 14.3±8.1%, P<0.01, RV-GLS, 11.6±5.1% vs. 16.4±3.9%, P<0.01, RASr, 10.2±7.3% vs. 20.7±9.5%, P<0.01). RASr was significantly associated with all-cause death after adjusting for RV-GLS, LV-GLS and LASr (hazard ratio [HR]: 0.91, 95% confidence interval [95% CI]: 0.83-0.99, P<0.05). RASr and log-transformed BNP were significantly associated with all-cause death after adjusting for log-transformed troponin T and eGFR (RASr, HR: 0.93, 95% CI: 0.87-1.00, P<0.05; log-transformed BNP, HR: 2.10, 95% CI: 1.17-3.79, P<0.05). The optimal cut-off values were RASr: 16.4% (sensitivity: 66%, specificity: 84%, area under curve [AUC]: 0.81) and BNP: 311.2pg/mL (sensitivity: 83%, specificity: 78%, AUC: 0.82) to predict all-cause mortality using ROC analysis. Kaplan-Meier analysis revealed that patients with low RASr (<16.4%) or high BNP (>311.2pg/mL) had a significantly high probability of all-cause death (both, P<0.01). We devised a new staging score by adding 1 point if RASr decreased or BNP levels increased more than each cut-off value. The HR for all-cause death using score 0 as a reference was 5.95 (95% CI: 1.19-29.79; P<0.05) for score 1 and 23.29 (95% CI: 5.37-100.98; P<0.01) for score 2. The new staging system using RASr and BNP predicted prognosis in patients with AL cardiac amyloidosis.

RELATIONSHIPS OF OFFICE, AMBULATORY, AND HOME BLOOD PRESSURE WITH ORGAN INJURY BIOMARKERS

Objective: International guidelines recommend out-of-office blood pressure (BP) monitoring including ambulatory and home BP. Although the superiority of ambulatory and home BP is controversial, home BP is more prevalent in plactice and there is a gap with the guidelines. We assessed this issue by conducting the analysis of relationship of BP with clinical biomarkers. Design and method: We analyzed the relationship of office, ambulatory, and home BP with organ injury biomarkers including urine-albumin creatinine ratio (UACR), serum b-type natriuretic peptide (BNP), serum high-sensitive troponin T (hsTnT), echocardiographic left ventricular mass index (LVMI), and brachial-ankle pulse wave velocity (baPWV) in 1,172 outpatients who underwent both ambulatory and home BP measurements and examined serum and urine tests and others. Results: In the univariate analysis of Pearson's correlation, average of morning and evening home systolic BP (SBP) was strongly related with log-transformed BNP, log-transformed hsCRP, LVMI, and baPWV compared with 24-h ambulatory systolic BP (log-transformed UACR [n = 1432], r = 0.24 in home SBP versus r = 0.18 in ambulatory SBP, P = 0.17 in z-test for comparison of these correlations; log-transformed BNP [n = 1432], r = 0.17 vs. r = -0.04, P&lt;0.01; log-transformed hsTnT [n = 1092], r = 0.19 vs. r = -0.03, P&lt;0.01; LVMI [n = 1036], r = 0.23 vs. r = 0.10, P&lt;0.01; baPWV [n = 1361], r = 0.31 vs. r = 0.08, P&lt;0.01). In the multivariable linear regression models for log-transformed BNP, log-transformed hsTnT, and LVMI, the model-fit were improved when adding home SBP to the model including 24-h ambulatory SBP, but these relationships were not shown in vice versa. In addition, we also used Structural Equation Modeling for assessment of relationship of office, ambulatory, and home SBP with clinical biomarkers. Conclusions: Our findings suggested the superiority of home BP in the relationship with several biomarkers for hypertensive organ damage compared with ambulatory BP, which may provide a rationale for the management on hypertension using home BP monitoring in clinical practice conducted in many countries including Japan.

Association of Redox State of Human Serum Albumin with Severity in Patients with Heart Failure

Oxidative stress plays a crucial role in the progression of heart failure (HF). We surveyed the fraction of human mercaptalbumin [f (HMA) ], an indicator of the redox state of human serum albumin (HSA), in patients with HF and examined whether f (HMA) is associated with the severity of HF.We enrolled consecutive elderly patients hospitalized for acute HF or exacerbation of HF. The redox state of HSA was measured by the high-performance liquid chromatography with postcolumn bromocresol green method using serum samples collected close to discharge. First, the distribution of f (HMA) in HF was compared to that in community-dwelling elderly individuals (n = 125; median age, 80 years) as a control group analyzed in a previous study. Overall, 133 patients (median age, 81 years; 75 men) were included. Patients with HF showed a lower level of f (HMA) than those of the control group (55.0% [IQR 47.7-61.3] versus 66.3% [IQR 62.8-70.0], P < 0.001]. Multiple regression analysis showed a negative correlation between f (HMA) and log-transformed B-type natriuretic peptide (standardized beta = -0.19).Patients with HF showed lower f (HMA) than those in the control group. Additionally, f (HMA) was related to HF independently with log-transformed B-type natriuretic peptide in the multivariate regression analysis, suggesting that f (HMA) is a biomarker that reflects the redox state in HF patients.

Association of B-type natriuretic peptide with rapid progression in patients with aortic stenosis.

Rapid progression of aortic stenosis (AS) is associated with poor outcomes, and the impact of B-type natriuretic peptide (BNP) on AS progression remains unknown. The purpose of the present study was to investigate the association between BNP level and the AS progression rate. From January 2016 to June 2021, 200 AS patients with progression who had at least two transthoracic echocardiograms with a maximum interval of 180 days were retrospectively analyzed. Rapid progression of AS was defined as the annual increase of aortic jet velocity (Vmax) ≥0.3 m/s/year. For analyses, both the log-transformed BNP and the BNP ratio were used. The linear regression and binary logistic regression analyses were used to determine the association between BNP and the AS progression. At a median echocardiographic follow-up of 595 days, the annual median (interquartile) progression of Vmax was 0.26 (0.09-0.58) m/s/year. Patients with rapid progression had higher age, log BNP, and higher percentage of diabetes and male gender. Higher tertiles of log BNP and BNP ratio had more rapid increase in Vmax (p = 0.018 and 0.033, respectively). BNP ratio significantly correlated with Vmax progression in univariate and multivariate linear regression analyses (p < 0.001 and p = 0.001, respectively). Moreover, both the univariate and multivariate binary logistic regression analyses showed that the log BNP and BNP ratio were associated with the rapid progression of AS (p < 0.050 for all). Higher BNP was independently associated with the rapid progression of AS.

Sex Differences in Time-Dependent Changes in B-Type Natriuretic Peptide in Hypertrophic Cardiomyopathy.

Background: Female sex is reported to be associated with poor prognosis in hypertrophic cardiomyopathy (HCM). The plasma B-type natriuretic peptide (BNP) concentration is a prognostic predictor in HCM. However, the effect of sex on BNP concentrations remains unclear among HCM patients.Methods and Results: Patient records in the Clinical Personal Records of HCM national database of the Japanese Ministry of Health, Labour and Welfare from 2009 to 2014 were analyzed. Of 3,570 HCM patients, 611 in whom BNP concentrations were assessed at both baseline and the 2-year follow-up were included in this analysis. The mean age was 60.4 years and 254 (41.6%) patients were female. Median (interquartile range) BNP concentrations were higher in females than males at both baseline (320.3 [159.0–583.1] vs. 182.8 [86.1–363.9] pg/mL; P<0.001) and the 2-year follow-up (299.2 [147.0–535.3] vs. 161.0 [76.2–310.0] pg/mL; P<0.001). Female sex was associated with higher natural log-transformed BNP at the 2-year follow-up regardless of clinical characteristics, including echocardiographic findings and BNP concentrations at baseline (coefficient 0.31; 95% confidence interval 0.13–0.48; P<0.001). Cubic spline analysis showed that, among patients with high BNP concentrations at baseline, females had higher BNP concentrations at the 2-year follow-up than males.Conclusions: In HCM, female sex was associated with higher BNP concentrations than male sex, independent of clinical characteristics, including BNP concentrations at baseline.

Relationship of ejection fraction and natriuretic peptide trajectories in heart failure with baseline reduced and mid-range ejection fraction

BackgroundThe prognostic importance of trajectories of neurohormones relative to left ventricular function over time in heart failure with reduced and mid-range EF (HFrEF and HFmrEF) is poorly defined. ObjectiveTo evaluate left ventricular ejection fraction (LVEF) and B-type natriuretic peptide (BNP) trajectories in HFrEF and HFmrEF. MethodsAnalyses of LVEF and BNP trajectories after incident HF admissions presenting with abnormal LV systolic function were performed using 3 methods: a Cox proportional hazards model with time-varying covariates, a dual longitudinal-survival model with shared random effects, and an unsupervised analysis to capture 3 discrete trajectories for each parameter. ResultsAmong 1,158 patients (68.9 ± 13.0 years, 53.3% female), both time-varying LVEF measurements (P=.001) and log-transformed BNP measurements (p-values=2 × 10−16) were independently associated with survival during 6 years after covariate adjustment. In the dual longitudinal/survival model, both LVEF and BNP trajectories again were independently associated with survival (P<.0001 in each model); however, LVEF was more dynamic than BNP (P <.0001 for time covariate in LVEF longitudinal model versus P=.88 for the time covariate in BNP longitudinal model). In the unsupervised analysis, 3 discrete LVEF trajectories (dividing the cohort into approximately thirds) and 3 discrete BNP trajectories were identified. Discrete LVEF and BNP trajectories had independent prognostic value in Kaplan-Meier analyses (P<.0001), and substantial membership variability across BNP and LVEF trajectories was noted. ConclusionAlthough LVEF trajectories have greater temporal variation, BNP trajectories provide additive prognostication and an even stronger association with survival times in heart failure patients with abnormal LV systolic function.

Cerebral oxygen saturation (rSO2) during cardiopulmonary bypass (CPB) measured using the INVOS oximeter closely correlates with baseline rSO2.

Baseline cerebral regional saturation (rSO2) measured using the INVOS 5100C (Medtronic, MN, USA) varies widely among patients with cardiac and/or renal diseases. To identify significant correlates of baseline rSO2 and to investigate intraoperative rSO2 changes, we conducted a retrospective study in 494 patients undergoing on-pump cardiovascular surgery. Correlations between preoperative blood laboratory test variables and baseline rSO2 before anesthesia were examined. Intraoperative rSO2 changes were analyzed. Of all the variables examined, log-transformed B-type natriuretic peptide (BNP) most significantly and negatively correlated with baseline rSO2 (r = - 0.652, p < 0.0001). Intraoperatively, rSO2 showed the lowest value during cardiopulmonary bypass (CPB) (median rSO2: 56.2% during CPB vs. 63.9% at baseline, p < 0.0001). Although rSO2 during CPB correlated positively with hemoglobin concentration and oxygen delivery during CPB (r = 0.192, p < 0.0001; and r = 0.172, p = 0.0001, respectively), it correlated much more closely with baseline rSO2 (r = - 0.589, p < 0.0001). Thus, patients showing low baseline rSO2 primarily associated with preoperatively high BNP continued to show low rSO2 even during CPB independent of hemodynamics artificially controlled by CPB. Our findings suggest that low baseline rSO2 in patients with high BNP due to cardiac and/or renal diseases is more likely to result from tissue edema causing alterations in optical pathlength and thus in calculated rSO2 values, not readily modifiable with CPB, rather than actual cerebral hemodynamic alterations readily modifiable with CPB. These may partly explain why the INVOS oximeter is a trend monitor requiring baseline measures.

BIRTH WEIGHT AND RISK FACTORS FOR ATHEROSCLEROSIS -RETROSPECTIVE COHORT STUDY IN JAPANESE WORKERS

Objective: Low birth weight is associated with chronic health conditions later in life. B-type natriuretic peptide (BNP) is recently recognized as one of prognostic factors for cardiovascular events in general population. However, the association between the birth weight and BNP remains unclear. We aimed to examine the relation of birth weight with atherosclerotic risk factors including BNP among Japanese workers. Design and method: This study included 517 male and 592 female Japanese workers aged 40–70 years who attended an annual health checkup in 2018. The participants were divided into three groups according to their birth weight and evaluated the association between birth weight and risk factors for atherosclerosis including BNP, body mass index, blood pressure, creatinine, uric acid, triglyceride, HDL-cholesterol, LDL-cholesterol, glucose and HbA1c. Results: Trend test according to birth weight category showed that birth weight was inversely associated with HbA1c in men and with diastolic blood pressure in women, whereas it was not related with BNP levels in both men and women. Correlation coefficient test for birth weight data also revealed the correlation of birth weight with HbA1c in men (Pearson correlation coefficient -0.217, 95% CI [-0.350, -0.084]) and with diastolic blood pressure in women (-0.091, [-0.195, 0.000]), but not with log-transformed BNP level (-0.006, [-0.130, 0.142] for men, and -0.047 [-0.152, 0.057] for women). Multiple linear regression analysis indicated that birth weight was one of explanatory factors for HbA1c and regression model including birth weight, body mass index, ALT, creatine, hemoglobin, WBC, and platelet predicted HbA1c levels in men (R2 = 0.278). Conclusions: The present study showed no significant association between birth weight and BNP, whereas inverse associations of birth weight with HbA1c in men and with diastolic blood pressure in women were found. These data suggest that the birth weight may partially predict the future risk factors for atherosclerosis.

B-type natriuretic peptide levels and volume status in twice-weekly hemodialysis patients

Background Twice-weekly hemodialysis (HD) could be regarded as an important part of incremental hemodialysis, volume status of this treatment model remains to be elucidated. Methods Patients undergoing regular twice-weekly or thrice-weekly hemodialysis in our unit on June 2015 were enrolled into the cohort study with an average of 2.02 years follow-up. Volume status of the subjects was evaluated by clinical characteristics, plasma B-type natriuretic peptide (BNP) levels and bioimpedance assessments with body composition monitor (BCM). Cox proportional hazards models and Kaplan–Meier analysis were used to compare patient survival between the two groups. Results Compared with patients on thrice-weekly HD, twice-weekly HD patients had significantly higher log-transformed BNP levels (2.54 ± 0.41 vs. 2.33 ± 0.49 pg/ml, p = 0.010). Overhydration (OH) and the ratio of overhydration to extracellular water (OH/ECW) in twice-weekly HD group were significantly higher than that of thrice-weekly HD (OH, 2.54 ± 1.42 vs. 1.88 ± 1.46, p = 0.033; OH/ECW, 0.17 ± 0.07 vs. 0.12 ± 0.08, p = 0.015). However, subgroup analysis of patients within 6 years HD vintage indicated that the two groups had similar hydration status. Multivariate Cox regression analysis showed that log-transformed BNP levels, serum albumin and diabetes status were predictors of mortality in hemodialysis patients. Kaplan–Meier survival analysis indicated that patients with BNP levels higher than 500 pg/ml had significantly worse survival compared with those with lower BNP levels (p = 0.014). Conclusions Twice-weekly hemodialysis patients had worse volume status than that of thrice-weekly HD patients especially for those with long-term dialysis vintage, BNP level was a powerful predictor of mortality in HD patients.

Right atrial mechanics by strain echocardiography in chronic thromboembolic pulmonary hypertension

Abstract Introduction Chronic thromboembolic pulmonary hypertension (CPTEH) is the result of thromboemboli leading not only to mechanical obstruction but also pulmonary vascular remodelling and progressive increase in right heart afterload. Prognostic assessment in CPTEH is complex and multifactorial. Purpose We used two-dimensional strain echocardiography (2D-STE) to quantify right atrial (RA) mechanics and its correlation with invasive hemodynamics, load-dependent biomarkers and well-known prognostic markers in patients with CTEPH. Methods A total of 44 patients (24 females, mean age 61±15.6 years) with CTEPH were recruited. 2D-STE was used to measure right atrial reservoir strain (RASr) (Figure 1) which was then compared to conventional ultrasound measurements, right heart catheterisation (RHC) measurements, the percentage of obstruction in ventilation-perfusion pulmonary single-photon emission computed tomography (V/Q SPECT), B-type natriuretic peptide (BNP) values and 6-minute walk test (6MWT) performance. All patients underwent transthoracic echocardiographic evaluation with a maximal time distance of three months to RHC. Results There was a significant positive correlation of RASr with RV longitudinal function determined by tricuspid annular plane systolic excursion (TAPSE) (r=0.488, p=0.003), tricuspid annular peak systolic velocity (S') (r=0.490, p=0.002), right ventricular outflow tract velocity time integral (RVOT VTI) (r=0.457, p=0.005), as well as with 6MWT (r=0.491, p=0.004). There was a significant negative correlation of RASr with mean pulmonary artery pressure (r=−0.513, p=0.002), pulmonary vascular resistance (r=−0.439, p=0.011) and right atrial pressure (RAP) (r=−0.513, p=0.002). RASr was also correlated with Log-transformed BNP values (r=−0.552, p&amp;lt;0,001), and in a multivariate linear regression model, RASr was an independent predictor of Log-transformed BNP values (β=−0.448, 95% CI: −0.046 to −0.009; p=0.005). There was no correlation between RASr and the percentage of obstruction in V/Q SPECT (r=0.164, p=0.388). Conclusion 2D-STE-derived RA mechanics demonstrated to be a useful, non-invasive, surrogate measurement of RHC parameters. It also predicted important clinical/laboratory prognostic measurements, such as BNP and 6MWT performance. The absence of correlation between 2D-STE values and the percentage of vessel obstruction determined by SPECT may suggest that RV maladaptive response to the obstruction, rather than the degree of obstruction, dictates right heart failure in CTEPH. Right atrial strain components Funding Acknowledgement Type of funding source: None

Free triiodothyronine (fT3) and B-type natriuretic peptide (BNP) predict in-hospital mortality after valve surgery.

Increased B-type natriuretic peptide (BNP) and decreased free triiodothyronine (fT3) are associated with increased mortality after cardiac surgery. However, previous studies have addressed mortality primarily in patients undergoing coronary artery bypass graft, and not in those undergoing valve surgery. We assessed abilities of BNP and fT3 to predict mortality after valve surgery. This retrospective study included 1050 consecutive patients who underwent valve surgery with normothermic cardiopulmonary bypass (CPB). Predictors of in-hospital mortality were identified with logistic regression analyses. Cutoff values were determined with receiver operating curve analyses. There were 23 deaths (2.2%). By univariate analyses, fT3, log-transformed BNP (log BNP), cholinesterase, estimated glomerular filtration rate, and albumin were profoundly associated with in-hospital mortality (p < 0.0001 for each). By a multivariate analysis, however, only fT3 and log BNP remained significant (p = 0.0053 and p = 0.0449, respectively). fT3 and log BNP remained significant after adjustment for CPB time, and also after adjustment for the EuroSCORE II or JapanSCORE (p < 0.05 for each). Odds ratio and 95% confidence interval from univariate binary analysis for in-hospital mortality were 7.22 (3.12-17.58) for fT3 ≤ 2.21pg/mL, 6.01 (2.54-15.77) for BNP ≥ 219pg/mL, and 9.79 (4.21-22.74) for both combined (p < 0.0001 for each). fT3 and BNP predict in-hospital mortality after valve surgery, independent of each other, independent of CPB time, and independent of established mortality risk SCOREs. Additions of fT3 and BNP may enhance predictive utilities of established mortality risk SCOREs.

Log-transformed B-type natriuretic peptide as a prognostic predictor in patients undergoing cardiovascular surgery.

ObjectiveThis study was performed to explore the association between circulating B-type natriuretic peptide (BNP) and other mortality-related factors in patients undergoing cardiovascular surgery.MethodsIn this observational study, multilevel linear regression analysis and multilevel survival analysis were performed to measure the log-transformed BNP (lnBNP) value at four time points in 197 patients with 788 repeated data measurements. Effects of the interaction between the time points and the two intervention groups (cardiac surgery and vascular surgery) were also investigated. Six models were evaluated to identify the best fit for the data. Stata/MP® version 14.2 (Stata Corp., College Station, TX, USA) was used to analyze the two-level variance component model fitting.ResultsThere were significant differences in the fixed-effect parameters of lnBNP, such as the time point, age, body mass index, emergency operation, prognostic nutritional index, and estimated glomerular filtration rate. According to the multilevel survival analysis for all-cause death and vascular death, lnBNP significantly differed and was a common prognostic marker.ConclusionAs lnBNP increased by 1 point, all-cause death increased 2.07 times and vascular death increased 3.10 times. lnBNP is an important prognostic predictor and quantitative biochemical marker in patients undergoing cardiovascular surgery.

Correlation between B-Type Natriuretic Peptide and N-Terminal pro-B-Type Natriuretic Peptide in a Large Japanese Population at Risk of Stage A Heart Failure

Background: The measurements of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are useful for ruling out heart failure and as prognostic markers in not only heart failure populations but also general populations. It is not clear whether these two biomarkers are elevated in parallel or associated with demographic characteristics in large populations at risk of stage A heart failure. Here we investigated the relationship between BNP and NT-proBNP and extended the evaluation of this association to known demographic disparities in stage A heart failure. Methods: Of 4,310 ambulatory patients, we analyzed the cases of the 3,643 (mean age 65 ± 11 years, 46% male, and 79% on antihypertensive medication) patients whose serum BNP and NT-proBNP levels were both measured and who had a history of and/or risk factors for cardiovascular disease from the Japan Morning Surge-Home Blood Pressure (J-HOP) Study dataset. Results: The median (25th–75th percentiles) BNP and NT-proBNP values were 18.7 (9.3–38.5) pg/mL and 50.3 (25.5–97.4) pg/mL. There was a significant association between log-transformed BNP and log-transformed NT-proBNP (r = 818, p < 0.001). A multiple linear regression analysis showed that log-transformed NT-proBNP was significantly associated with log-transformed BNP (beta coefficient = 0.774, p < 0.001). When stratified by demographic characteristics, these associations remained (all p < 0.001). Conclusion: In a large Japanese population at risk of stage A heart failure, there was a significant association between BNP and NT-proBNP after adjustment and stratification by demographics.

B-Type Natriuretic Peptide and Hemoglobin are Two Major Factors Significantly Associated With Baseline Cerebral Oxygen Saturation Measured Using the INVOS Oximeter in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery

To investigate an association between the preoperative plasma B-type natriuretic peptide (BNP) concentration and cerebral regional saturation (rSO2) measured using the INVOS oximeter (Medtronic, Minneapolis, MN). A retrospective data analysis. Single university hospital. Patients undergoing off-pump coronary artery bypass (OPCAB) surgery. None. Associations of variables obtained from preoperative blood laboratory tests and transthoracic echocardiography with baseline rSO2 before induction of general anesthesia were investigated using bivariate and multivariate regression analyses in 330 OPCAB patients. With bivariate analyses, age; body size-related variables such as weight and body surface area; hematologic function-related variables such as blood hemoglobin (Hb) concentration and arterial oxygen saturation; renal function-related variables including estimated glomerular filtration rate, creatinine, and blood urea nitrogen; hepatic function-related variables including cholinesterase, albumin, total bilirubin, and alanine aminotransferase; serum electrolytes including sodium, chloride, and phosphorus; BNP or log-transformed BNP; and 13 transthoracic echocardiography variables such as left ventricular ejection fraction highly significantly correlated with baseline rSO2 (p < 0.0001). However, the multiple regression analysis revealed that only BNP and Hb remained major factors significantly associated with baseline rSO2 (p < 0.0001), while estimated glomerular filtration rate, arterial oxygen saturation, and body surface area remained minor factors (p < 0.05). Baseline rSO2 correlated better with log-transformed BNP than with BNP, indicating that rSO2 correlated with BNP in an exponential fashion. Preoperative BNP and Hb concentrations were 2 major factors associated with INVOS rSO2 in patients undergoing OPCAB.

Diagnostic value of B‐type natriuretic peptide for estimating left atrial size and its usefulness for predicting all‐cause mortality and cardiovascular events among chronic haemodialysis patients

Estimating fluid balance in haemodialysis patients is essential when determining dry weight, but limited methods are currently available. B-type natriuretic peptide (BNP) is a useful surrogate marker in patients with congestive heart failure (CHF), but whether its validity could be generalized to haemodialysis patients has not been studied well. A total of 457 haemodialysis patients at a dialysis centre were analyzed. Determinants of BNP were assessed in connection with ultrasound cardiography (UCG) records, Kt/V, ultrafiltration rate (UFR), and demographic factors. All-cause death and cardiovascular (CV) events were recorded as the main outcome. Among the UCG records, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), were determinants of log-transformed (ln) BNP; UFR, age and sex were also significant. There was a positive correlation between BNP and LAD (r = 0.285, P < 0.001). Receiver operating characteristic (ROC) analysis revealed that BNP had 90% and 80% sensitivity to predict the presence of LA enlargement of 77.9 pg/mL and 133.2 pg/mL, respectively. Higher BNP and lower LVEF were associated with higher risk for developing all-cause death and CVD. In the adjusted model, patients with BNP higher than 471 pg/mL had hazard ratio of 2.18 (95% confidence interval (CI) 1.20-3.96, P = 0.01), compared to those with BNP <109 pg/mL. B-type natriuretic peptide was determined by LAD, LVEF, UFR, age and sex. BNP and LAD had positive correlation and BNP could become a useful tool for estimating the presence of LA enlargement. BNP and LVEF was a strong risk factor for predicting all-cause death and CV events among patients undergoing haemodialysis.

Abstract 451: Central Hemodynamics Constitutes the Link Between Microalbuminuria and Elevated B-type Natriuretic Peptide Level: Implication for Cardio-renal Syndrome in Hypertension

Recent research has noted a pathological link between the heart and kidney, known as cardio-renal syndrome. However, little is clear about the pathophysiological mechanism behind it. A relationship of altered central hemodynamics to microalbuminuria in hypertension has been demonstrated ( Hypertension 2011;58:839-846). The present study was conducted to investigate two hypotheses: 1) a link between albuminuria and plasma B-type natriuretic peptide (BNP); and 2) involvement of central hemodynamics in this link. In 392 patients with uncomplicated hypertension (age, 56±12 years), the radial pressure waveforms were recorded with applanation tonometry to estimate the central aortic pressure parameters. The pulse wave velocity (PWV) was measured in carotid-femoral (aortic) and carotid-radial (peripheral) regions. Albuminuria was defined as urinary albumin/creatinine ratio (UACR) ≥30 mg/g of creatinine. The log-transformed BNP (median, 14 pg/ml) was correlated ( P ≤0.006) with aortic systolic ( r =0.31) and pulse ( r =0.46) pressures, aortic forward ( r =0.41) and augmented ( r =0.26) pressures, mean arterial pressure ( r =0.14), and aortic ( r =0.39) but not peripheral ( r =–0.09) PWV. The correlation with the aortic pulse pressure tended to be closer than the brachial pulse pressure ( P =0.07). The BNP was correlated ( P &lt;0.001) positively with UACR ( r =0.34), and negatively with estimated glomerular filtration rate (eGFR, r =–0.39). The presence of albuminuria was associated with an elevation of BNP (≥40 pg/ml) in a stepwise logistic model adjusted for age, body mass index, diabetes, eGFR, use of renin-angiotensin inhibitors and β-blockers (odds ratio: 2.74; P =0.007). Of note, however, additional adjustment for the aortic pulse pressure rendered this association statistically insignificant, and the aortic pulse pressure emerged as the strongest predictor of the BNP elevation (odds ratio: 1.41 per 10mmHg increase; P =0.003). In each patient subgroup with normo-, micro-, and macro-albuminuria, wider aortic pulse pressure was always associated with higher BNP level. In conclusion, albuminuria and elevated BNP are closely connected in hypertension. The central hemodynamics plays a pivotal role in mediating this cardio-renal connection.

Reduced Diurnal Variation of Heart Rate is Associated With Increased Plasma B-Type Natriuretic Peptide Level in Patients With Atrial Fibrillation

The plasma B-type natriuretic peptide (BNP) level has been shown to be increased in patients with chronic atrial fibrillation (AF) independent of left ventricular ejection fraction (LVEF). The purpose of this study is to evaluate the relationship between the plasma BNP level and heart rate variation in patients with AF. The plasma BNP level is associated with heart rate variation in patients with AF. A total of 102 patients with AF and preserved LVEF were included from 2 hospitals. The ambulatory electrocardiographic recording and measurement of plasma BNP levels were performed simultaneously. Echo-Doppler parameters were measured as the average of 10 consecutive cardiac cycles. A difference in the mean heart rate between night and day (DIFF) and the standard deviation of the 5-miniute mean R-R interval (SDARR) were significantly associated with log-transformed BNP levels (r = -0.411, P < 0.001 and r = -0.243, P = 0.049, respectively). In echocardiography, the ratio of E velocity to early diastolic velocity, which reflects left ventricular (LV) filling pressure, was significantly correlated with the DIFF and SDARR, along with the log-transformed BNP level. Stepwise multiple linear regression analysis revealed that the DIFF and age were independent factors related with the BNP level (P < 0.01). The reduced diurnal variation of heart rate was significantly associated with increased BNP, which is linked to LV diastolic dysfunction in patients with AF.

Interrelationship between haemodynamic state and serum intact parathyroid hormone levels in patients with chronic heart failure

ObjectiveTo assess the impact of serum intact parathyroid hormone (PTH) levels on haemodynamic state and their relations by comparing plasma B-type natriuretic peptide (BNP) levels.DesignCross-sectional study in molecular epidemiology.SettingMie University...

Novel Risk Factors for Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia; the lifetime risk is 1 in 4 for persons over the age of 40 years in the United States.1 AF is associated with an increased risk of death, dementia, heart failure, and stroke.2–5 AF leads to high healthcare system utilization rates.6 Based on current US age- and sex-specific prevalence data, the national incremental AF cost in 2010 is estimated to range from $6.0 to $26.0 billion.7 Risk factors for AF are diverse8 and include advancing age, male sex, diabetes mellitus, hypertension, valvular disease, myocardial infarction, heart failure, obesity, elevated inflammatory marker concentrations, and PR-interval prolongation, as recently reviewed elsewhere.9 Risk prediction models are important to define individual risk for AF, to identify novel risk factors for AF, to identify and assess potential targets of therapy, and to enhance the cost-effective implementation of therapies for both primary and secondary prevention of AF.10 A recently published risk score for the development of AF based on the established cardiovascular risk factors accounted for only part of the AF risk (C-statistic 0.76).11 Thus, although many risk factors for AF have been described, a substantial proportion of AF risk still remains unexplained. In the past years, multiple novel AF risk factors have been studied. In the present review, we aim to describe recently described risk factors and will underscore that substantial efforts are needed to incorporate novel markers of AF into risk prediction models. Efforts to optimize risk prediction models and prevention algorithms are useful for risk communication, patient motivation, and clinical decision making.10 ### Familial Aggregation In recent years, increasing data have been reported supporting the notion that AF in the general population is heritable. Diverse population-based studies have demonstrated that familial clustering of AF is common. …

Insulin‐like growth factor axis (insulin‐like growth factor‐I/insulin‐like growth factor‐binding protein‐3) as a prognostic predictor of heart failure: association with adiponectin

Insulin-like growth factor (IGF)-I is a regulator of glucose/fatty acid metabolism and may be involved in the pathophysiology of cardiovascular disease, but it remains unclear whether endogenous IGF-I is associated with the prognosis of heart failure (HF). We investigated whether the IGF axis, the ratio of IGF-I to IGF-binding protein-3 (IGFBP-3), was a predictor of clinical outcomes in HF. The association of IGF axis with serum adiponectin level, a prognostic marker of HF as well as a regulator of glucose/fatty acid metabolism, was also analysed. We measured serum IGF-I and IGFBP-3 in 142 HF patients with left ventricular systolic dysfunction and 63 control subjects. Patients with HF underwent clinical assessment and measurement of adiponectin and B-type natriuretic peptide (BNP). Compared with controls, HF patients showed significantly decreased serum IGF axis values [median (inter-quartile ranges), 0.114 (0.063-0.150) vs. 0.099 (0.052-0.158), P = 0.042]. In HF patients, the log-transformed IGF axis values were inversely correlated with the log-transformed serum adiponectin levels (r = -0.35, P < 0.0001) and plasma BNP levels (r = -0.25, P = 0.0028). The IGF axis was lower in patients with New York Heart Association (NYHA) functional class III/IV than those with class I/II [0.071 (0.044-0.145) vs. 0.107 (0.068-0.161), P = 0.022]. Furthermore, a decrease in IGF axis was associated with increased rates of all-cause mortality (P = 0.013), cardiac death (P = 0.035), and a composite of cardiac death and re-hospitalization (P = 0.0085). Insulin-like growth factor axis is a significant predictor of clinical outcomes in HF and is significantly associated with serum adiponectin levels.