Median Brain Natriuretic Peptide Research Articles

Abstract 4128526: Brain Natriuretic Peptide is Not Predictive of Days Alive and Out of Hospital During the Interstage Period in Infants with Hypoplastic Left Heart Syndrome

Background: Infants with hypoplastic left heart syndrome (HLHS) have the highest risk of morbidity and mortality during the interstage period. Brain natriuretic peptide (BNP) is frequently measured during the Stage I palliation (S1P) hospitalization. However, there is limited data on the association of BNP with interstage morbidity and mortality. In this context, we sought to examine the association between maximum BNP during the S1P hospitalization and last BNP prior to S1P discharge with days alive and out of hospital (DAOH) during the interstage period. We hypothesized that patients with higher BNPs during their S1P hospitalization would have fewer DAOH during the interstage period. Methods: We performed a single-center retrospective cohort study of infants with HLHS who underwent S1P at our institution between December 1, 2010 and December 31, 2022. Subjects were categorized based on maximum BNP and pre-discharge BNP tertiles. DAOH was calculated by subtracting the number of days hospitalized from the number of days alive during the interstage period. Multivariable zero-truncated negative binomial regression models were used to examine whether there was an association between BNP and DAOH. Models were adjusted for demographic, operative, and discharge characteristics and included an offset for interstage duration. Results: Of 251 infants, 221 (88%) had at least one BNP measured during their S1P hospitalization. The median maximum BNP was 529 (289-944) pg/mL, pre-discharge BNP was 346 (216-589) pg/mL, and DAOH was 97 (89-100) per 100 interstage days. The median maximum BNP in patients who remained admitted during the interstage period (n=32) was 1,027 (446-1,968) pg/mL which was significantly higher than the study cohort (p<0.001). Patients in the maximum BNP upper tertile were more likely to have moderate to severe atrioventricular valve regurgitation (p=0.04) and had higher pre-discharge and pre-Stage 2 palliation BNPs (p<0.001). There was no association between either maximum BNP or pre-discharge BNP with DAOH. Patients in the maximum BNP upper tertile had significantly more BNPs collected during their S1P hospitalization and interstage period. Conclusions: BNP during the S1P hospitalization is not predictive of interstage DAOH. In patients deemed candidates for discharge after S1P, repeated BNP measurements may have limited utility. Further work is needed to assess the association between BNP measured in the interstage period and longer-term outcomes.

Residual congestion in acute decompensated heart failure: A novel approach through microvascular imaging of renal circulation

Abstract Background In patients admitted for acute decompensated heart failure (ADHF), residual congestion at discharge is associated with adverse clinical outcomes. Traditionally, the extent of congestion has been inferred from central venous pressure, but it has also been highlighted that this is insufficient for a comprehensive evaluation of residual congestion. On the other hand, renal congestion is an important finding of organ congestion, and Superb Microvascular Imaging (SMI), a technique that reveals minute flow details, is promising for assessing renal circulation. We hypothesized that in patients with ADHF, assessment of renal circulation using SMI may be superior to conventional methods in assessing residual congestion. Methods In this prospective study, we enrolled 45 consecutive patients admitted with ADHF. We performed comprehensive evaluations including blood tests, echocardiography, and renal ultrasonography using SMI. The vascular index (VI), as measured by SMI, was calculated as the percentage of blood flow signal area in the region of interest. Subsequently, we calculated the intra-renal perfusion index (IRPI), representing cyclic variation in VI, as (maximum VI - minimum VI) within one cardiac cycle, divided by the maximum VI (Figure). Brain Natriuretic Peptide (BNP) levels were utilized to evaluate the state of decongestion. Results At discharge, the mean IRPI was 0.61±0.04, while the median BNP levels were 204.9 pg/ml (interquartile range: 102.7, 428.2). Patients exhibiting elevated log BNP levels at discharge (>2.31, based on median value) displayed significantly higher IRPI values [0.61(0.49, 0.86) vs 0.53(0.35, 0.59), p=0.02] and were older (80.8±8.5 vs 70.3±14.9 years, p=0.010). However, no significant differences were observed regarding laboratory parameters including hematocrit and creatinine levels, as well as echocardiographic parameters such as ejection fraction, E/e' ratio, and estimated right atrial pressure (RAP). Moreover, at discharge, creatinine levels (p=0.56) and estimated RAP (p=0.06) exhibited no significant correlation with IRPI. Conclusion Renal circulation evaluated by SMI may serve as a useful indicator of the extent of residual congestion at discharge compared to blood tests and echocardiographic estimates of right atrial pressure in patients admitted for ADHF.

Impact of global longitudinal strain and anemia for predicting cardiovascular mortality in patients hospitalized for acute heart failure with atrial fibrillation

Abstract Background Iron deficiency is a prognostic factor in heart failure (HF) with reduced ejection fraction (EF). In patients with atrial fibrillation (AF) and HF, left ventricular EF (LVEF) measurements are imprecise due to irregular tachycardia, but it is unclear whether global longitudinal strain (GLS) and anemia assessment are prognostic. Purpose We examined whether GLS and anemia predict cardiovascular death (CD) in patients with acute HF complicated by AF. Methods We retrospectively enrolled patients aged 18 years or older with acute HF complicated by AF who were consecutively admitted to our hospital from January 2014 to December 2018. Exclusion criteria were acute coronary syndromes, no transthoracic echocardiogram performed within 30 days before or after admission, and missing data. All patients were followed up from admission to CD (due to myocardial infarction, HF, stroke or sudden death), or were censored at the date of last contact or 3 years. Anemia was defined as hemoglobin < 12 g/dL in females and hemoglobin < 13 g/dL in males. Patients were divided into four groups according to median GLS and anemia status. Results A total of 320 patients (mean age 79 ± 12 years, 163 females) were included in the analysis. The median duration of AF was 1.2 years; 11% (36/320) had paroxysmal AF. The median brain natriuretic peptide value was 623 pg/ml, and 52% of the patients (165/320) were in New York Heart Association functional class 4. During a median follow-up of 528 days, 24% (77/320) patients were observed with CDs: 2 myocardial infarctions, 51 HF-related deaths, 6 strokes, and 18 sudden cardiac deaths. At the 3-year follow-up, the survival rate by the Kaplan-Meier curve was 89% (95% confidence interval (CI) 76%-95%) in the no anemia group with high GLS (< -10%) and 40% (95% CI 25%-54%) in the anemia group with low GLS (≥ -10%) (p < 0.001, log-rank test). In multivariate Cox regression analysis, GLS (adjusted hazard ratio (aHR) 1.06, 95% CI 1.01-1.14, p = 0.017) and hemoglobin (aHR 0.85, 95% CI 0.76-0.96, p = 0.009) were independent factors for CD, with a significantly increased risk in the anemia group with low GLS compared to the no anemia group with high GLS (aHR 4.11, 95% CI 1.59-10.6, p = 0.004). The results were consistent with no interaction by gender or LVEF 50%. Conclusions Anemic patients with low GLS with AF and HF may have poor prognosis. Prospective studies are needed to determine whether iron supplementation improves prognosis in such patients.

An Increase in the Ratio of Brain Natriuretic Peptide to Peak Transvalvular Pressure Gradient Suggests Coexistence of Cardiovascular Complications in Elderly Aortic Stenosis Patients.

The aim of this study was to differentiate between elderly aortic stenosis (AS) patients with and without cardiovascular complications (CCs).In total, 156 consecutive patients with AS aged ≥ 70 years were enrolled. Patients were divided into 2 groups as follows: AS without CCs (group I; n = 110) and AS with CCs (group II; n = 46). Routine electrocardiographic and echocardiographic parameters, peak and mean transvalvular pressure gradients (TPGs), aortic valve area (AVA), brain natriuretic peptide (BNP) levels, and BNP/peak TPG ratio were measured.The mean ages in groups I and II were 80.4 ± 5.5 and 82.5 ± 7.2 years. Left ventricular hypertrophy was greater in group II than in group I. Left ventricular end-diastolic and end-systolic dimensions and left ventricular fractional shortening were normal in both groups. Peak and mean TPGs were greater in group II (67.2 ± 39.3 and 40.2 ± 26.4 mmHg) than in group I (52.0 ± 23.0 and 30.2 ± 13.9, both P < 0.005); however, the AVA showed no significant difference between the 2 groups. The median BNP levels were 65.9 and 433.7 pg/mL in groups I and II (P < 0.0001). A correlation between peak TPG and BNP levels was observed in both groups. The BNP/peak TPG ratio was < 3.0 in all patients of group I and ≥ 3.0 in almost all patients of group II (P< 0.0001). The area under the curve using BNP/peak TPG ratio was 0.9883.BNP and BNP/peak TPG ratio could differentiate between AS with and without CCs in elderly patients.

Assessment of biomarkers and clinical parameters as predictors of survival in patients with chagasic heart failure.

Chagas disease, endemic in Latin America and spreading globally due to emigration, has a significant health burden, particularly in relation to chagasic heart failure (HF). Chagasic cardiomyopathy (CCM) is characterized by chronic inflammatory myocardial disease. This study aimed to identify inflammatory parameters and biomarkers that could aid in the management of patients with chagasic HF. A cohort study was conducted at a tertiary cardiology single-center over a mean follow-up period of 2.4 years. The study included patients with HF secondary to CCM enrolled between October 2013 and July 2017. Various clinical parameters, echocardiography findings, parasitemia status, brain natriuretic peptide (BNP) and troponin T (TnT) levels, and inflammatory biomarkers (IL-6, IL-10, IL-12p70, IL-17A, adiponectin, and IFN-γ) were assessed. The study encompassed a cohort of 103 patients, with a median age of 53 years and 70% being male. The left ventricular ejection fraction (LVEF) was 28%, with 40% of patients classified as NYHA II functional class. The median BNP level was 291 pg/ml. The observed mortality rate during the study period was 38.8%. Predictors of lower survival were identified as elevated levels of BNP, TnT, reduced LVEF, and increased adiponectin (thresholds: BNP > 309 pg/ml, TnT > 27.5 ng/ml, LVEF < 25.5%, adiponectin > 38 μg/mL). Notably, there was no evidence indicating a relationship between parasitemia and the inflammatory parameters with lower survival in these patients, including INF-γ, IL-6, IL-10, IL12-(p70), and IL17a. Despite the presence of a chronic inflammatory process, the evaluated inflammatory biomarkers in this cohort were not predictive of survival in patients with chagasic HF with reduced ejection fraction (HFrEF). However, reduced LVEF, elevated BNP, adiponectin levels, and troponin T were identified as predictors of lower survival in these patients.

Kord Kanı ve Yenidoğan Plazma Beyin Natriüretik Peptid Düzeyleri ile Doğum Şekli Arasındaki İlişki

Fetal-to-neonatal adaptation involves many complex mechanisms. Cardiovascular biomarkers may help to understand fetal and maternal physiology in pregnancy and during the perinatal transition period. In this present study, our aim was to assess the association between delivery type and brain natriuretic peptide (BNP) levels in healthy full-term neonates. Forty-eight neonates born by vaginal delivery (n=25) and cesarean section (n=23) were included in the study. Plasma BNP levels were measured at cord blood samples. In addition antropometric measurements and physical examination were evaluated at first day of life. BNP levels measure and clinical evaluation were repeated 3 days later after birth. The median cord and infant BNP levels were similar in vaginal and cesarean delivery. There was no difference between the median cord and infant BNP levels in vaginal deliveries [54.0 pg/ml (q1-q3: 40.0-111.5) and 66.0 pg/ml (q1-q3: 43.0-90.0) respectively, p=0.619]. However, the median infant BNP level was statistically significantly higher than the median cord BNP level [56.0 pg/ml (q1-q3: 39.0-84.0) and 75.0 pg/ml (q1-q3: 54.0-145.0), p=0.027] in cesarean deliveries. Uncomplicated vaginal deliveries were not associated with high BNP levels and thus fetal cardiac distress. Increased levels of BNP levels on the 3rd day in elective cesarean deliveries may be predictive of delayed postnatal pulmonary and cardiac adaptation.

The utility of brain natriuretic peptide as a prognosticating marker in critical care patients.

Brain natriuretic peptide (BNP) is an established biomarker of morbidity and mortality in cardiac failure. Data also suggest potential prognostic utility in non-heart failure cohorts. The utility of BNP in predicting intensive care unit (ICU) outcomes has not been well evaluated in a mixed critical care population in the South African (SA) context. To evaluate the ability of BNP to predict ICU mortality in a heterogeneous critical care population in SA. This was a retrospective observational study of 100 patients admitted to a multidisciplinary, closed, intensivist-run ICU in a tertiary academic hospital serving KwaZulu-Natal Province (1 January 2020 - 31 July 2022). Initial BNP was evaluated as a predictor of ICU mortality using univariate and multivariable analyses. There was a statistically significant difference in BNP between survivors and non-survivors in the cohort of patients without heart failure. The median initial BNP in the non-heart failure cohort was 411 (interquartile range (IQR) 116 - 848) ng/L in non-survivors, and 150 (44 - 356) ng/L in survivors (p=0.028). The optimal cut-off for BNP was determined as 366 ng/L. A BNP ≥366 ng/L was an independent predictor of ICU outcome. This study highlights the potential utility of BNP as a predictor of ICU mortality in a heterogeneous ICU population, with the greatest utility in patients without heart failure. Further studies are required to confirm this finding. The study is a retrospective, observational study conducted in multidisciplinary, closed, intensivist-run ICU at a tertiary academic hospital. It showed an elevated BNP is associated with increased ICU mortality, particularly in those without a baseline diagnosis of heart failure. This identifies the need for further prospective studies evaluating BNP as a prognostic marker in non-cardiac critically ill patients, and its utility as an addition in pre-existing ICU outcome prediction scores.

Laparoscopic Colorectal Cancer Surgery for Patients With Severe Chronic Heart Failure.

Laparoscopic surgery with pneumoperitoneum is not usually recommended for patients with heart failure due to the potential risks associated with cardiopulmonary stress. Few studies, however, have directly examined whether a laparoscopic approach can be used safely in patients with severe chronic heart failure. We retrospectively evaluated the safety and feasibility of laparoscopic colorectal cancer surgery in 13 patients with severe chronic heart failure, defined as left ventricular ejection fraction <40% and/or brain natriuretic peptide >100 pg/ml (NT-proBNP >400 pg/ml). Intraoperative hemodynamics, including systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate, were carefully monitored. The median left ventricular ejection fraction value was 35% (18-62%), and the median brain natriuretic peptide value was 171.7 pg/ml (109.5-961.4 pg/ml). The time-series mean ratio of the patients' blood pressure and heart rate during surgery indicated that soon after the induction of general anesthesia, mean blood pressure was significantly decreased (p<0.05) from baseline. In all 13 cases, laparoscopic surgery was performed successfully, with no significant complications. The present study showed that laparoscopic surgery for colorectal cancer can be performed safely in patients with severe chronic heart failure.

Association of red cell distribution width with pulmonary arterial hypertension in patients with mixed connective tissue disease

BackgroundPulmonary arterial hypertension (PAH) is a severe complication of mixed connective tissue disease (MCTD) and contributes to increased morbidity and mortality. Still, the demographic characteristics and risk factors of PAH in MCTD remain poorly understood. This study explored risk factors for PAH development in MCTD.MethodsData from patients with MCTD and PAH hospitalized from May 2009 to December 2022 in a single center were collected and compared with patients with MCTD without PAH. The variables were analyzed by logistic regression to identify the factors associated with PAH in patients with MCTD. The receiver-operating characteristic (ROC) curve was used to assess the diagnostic value of the identified factors.ResultsFinally, 119 patients with MCTD were included; 46 had PAH. The mean age at PAH onset and diagnosis was 38.9 ± 13.4 and 39.9 ± 13.7 years, respectively. The median pulmonary arterial systolic pressure (PASP) was 67.0 mmHg. The median brain natriuretic peptide (BNP) level was 180.0 pg/ml at PAH diagnosis. Red cell distribution width (RDW) (OR: 2.128; 95% confidence interval: 1.497–3.026; P < 0.001) was associated with PAH in patients with MCTD. There was a positive correlation between RDW and PASP (r = 0.716, P < 0.001). At a cutoff of 15.2%, RDW had the best sensitivity (80.4%) and specificity (82.2%) for PAH.ConclusionRDW may serve as a sensitive index to predict PAH in patients with MCTD.

Lower heart rates and beta-blockers are associated with new-onset atrial fibrillation

BackgroundLower heart rates (HRs) prolong diastole, which increases filling pressures and wall stress. As a result, lower HRs may be associated with higher brain natriuretic peptide (BNP) levels and incident atrial fibrillation (AF). Beta-blockers may increase the risk for AF due to suppression of resting HRs. ObjectiveExamine the relationships of HR, BNP, beta-blockers and new-onset AF in the REVEAL-AF and SPRINT cohort of subjects at risk for developing AF. MethodsIn REVEAL-AF, 383 subjects without a history of AF and a mean CHA2DS2VASC score of 4.4 ± 1.3 received an insertable cardiac monitor and were followed up to 30 months. In SPRINT, 7595 patients without prior history of AF and a mean CHA2DS2VASC score of 2.3 ± 1.2 were followed up to 60 months. ResultsThe median daytime HR in the REVEAL-AF cohort was 75bpm [IQR 68–83]. Subjects with below-median HRs had 2.4-fold higher BNP levels compared to subjects with above-median HRs (median BNP [IQR]: 62 pg/dl [37−112] vs. 26 pg/dl [13–53], p < 0.001). HRs <75bpm were associated with a higher incidence of AF: 37% vs. 27%, p < 0.05. This was validated in the SPRINT cohort after adjusting for AF risk factors. Both a HR < 75bpm and beta-blocker use were associated with a higher rate of AF: 1.9 vs 0.7% (p < 0.001) and 2.5% vs. 0.6% (p < 0.001), respectively. The hazard ratio for patients on beta-blockers to develop AF was 3.72 [CI 2.32, 5.96], p < 0.001. ConclusionsLower HRs are associated with higher BNP levels and incident AF, mimicking the hemodynamic effects of diastolic dysfunction. Suppression of resting HR by beta-blockers could explain their association with incident AF.

Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study

Tricuspid regurgitation pressure gradient (TRPG) measurement by echocardiography is recommended as the most objective examination to detect portopulmonary hypertension (PoPH). This study aimed to identify factors associated with a high TRPG in patients with cirrhosis and develop a scoring model for identifying patients who are most likely to benefit from echocardiography investigations. A total of 486 patients who underwent echocardiography were randomly allocated to the derivation and validation sets at a ratio of 2:1. Of the patients, 51 (10.5%) had TRPG ≥ 35mmHg. The median brain natriuretic peptide (BNP) was 39.5pg/mL. Shortness of breath (SOB) was reported by 91 (18.7%) patients. In the derivation set, multivariate analysis identified female gender, shortness of breath, and BNP ≥ 48.9pg/mL as independent factors for TRPG ≥ 35mmHg. The risk score for predicting TRPG ≥ 35mmHg was calculated as follows: - 3.596 + 1.250 × gender (female: 1, male: 0) + 1.093 × SOB (presence: 1, absence: 0) + 0.953 × BNP (≥ 48.9pg/mL: 1, < 48.9pg/mL: 0). The risk score yielded sensitivity of 66.7%, specificity of 75.3%, positive predictive value of 25.5%, negative predict value of 94.3%, and predictive accuracy of 74.4% for predicting TRPG ≥ 35mmHg. These results were almost similar in the validation set, indicating the reproducibility and validity of the risk score. This study clarified the characteristics of patients with suspected PoPH and developed a scoring model for identifying patients at high risk of PoPH, which may be used in selecting patients that may benefit from echocardiography.

Natriuretic peptides, extracellular volume, and subclinical cardiovascular changes in chronic kidney disease stages 1–3: a pilot study

Natriuretic peptide levels are elevated in persons with chronic kidney disease (CKD) stages 1–3, but it remains unclear whether this is associated with extracellular volume excess or early cardiovascular changes....

Predicting 1-Year Mortality in Ambulatory Heart Failure Patients: Empiric Models Outperform Physician Intuitive Estimates

<h3>Purpose</h3> This multicenter Canadian prospective cohort study evaluated the accuracy of physician predictions in comparison to model predictions in estimating 1-year mortality in ambulatory patients with heart failure (HF). <h3>Methods</h3> We included consented consecutive ambulatory HF patients (left ventricular ejection fraction (LVEF) <40%) followed at 11 HF clinics in 5 provinces in Canada (2018-2020). In a closed-question survey, HF cardiologists and family doctors, using their clinical judgment, estimated patient 1-year mortality in absolute terms. We collected clinical information to describe the population and calculate predicted mortality using three predictive models: the Seattle HF Model (SHFM), the MAGGIC score and the HF Meta-score. We documented patients' mortality over one year. Physicians were unaware of model predictions. We calculated mortality using Cox proportional hazards and assessed model and physician predictive accuracy using discrimination and calibration. <h3>Results</h3> We included 1,563 ambulatory HF patients, mean age of 63±14 years, 24% female, 70% NTHA class I-II, mean LVEF of 28±7%, and median brain natriuretic peptide of 350 pg/ml (25^th-75^th percentile 130-700). The population 1-year mortality was 7% (95%CI 6%-8%). Models' discrimination (c-statistic 0.80 for MAGGIC and HF meta-score, 0.84 for SHFM) proved superior to physicians (0.77 for family doctors and 0.78 for HF cardiologists). Models' calibration was adequate for patients at lower risk, but overestimated risk in those whose 1-year mortality was > 20%. In contrast, family doctors and HF cardiologists overestimated risk throughout the risk spectrum. In low-risk patients (1-year mortality ∼1%), physicians predicted a risk 7%-10%; in medium-risk patients (1-year mortality ∼5%), physicians predicted 15%-20%; and in high-risk patients (mortality >15%), physicians predicted >25%. <h3>Conclusion</h3> Predictive models showed higher accuracy in predicting 1-year mortality in ambulatory HF population than family doctors and HF cardiologists, both of whom consistently overestimated risk, potentially exposing patients early to more aggressive care. Incorporating predictive models in family and HF cardiology practices may improve patient management and resource use.

Relationship Between Serum Brain-Type Natriuretic Peptide and Biomarkers of Growth in Infants With Shunt-Dependent Single Cardiac Ventricle

For infants with shunt-dependent or ductal-dependent single ventricle heart disease, poor growth is common and associated with morbidity and impaired neurodevelopmental outcomes. Although attention has focused on nutrition to promote weight gain, little is known about the relation between heart failure and growth factors. A prospective observational pilot study was performed to assess the relation between heart failure, assessed by brain natriuretic peptide (BNP), and growth factors (insulin-like growth factor 1 [IGF-1] and insulin-like growth factor-binding protein 3) at 3 visits: (1) before discharge from neonatal intervention with the establishment of stable pulmonary blood flow, (2) immediately before superior cavopulmonary connection, and (3) before discharge after superior cavopulmonary connection operation. The relation between BNP and growth factors was analyzed using Spearman pairwise correlations at each visit and modeled over time with a linear mixed-effects model. Correlations were considered worthy of further exploration using a p <0.10, given the exploratory nature of the study. The study included 38 infants (66% male, 68% hypoplastic left heart syndrome). Median BNP was elevated at visit 1 and decreased over time (287pg/dl [interquartile range 147 to 794], 85pg/dl [52 to 183], and 90pg/dl [70 to 138]). Median IGF-1 Zscore was <0 at each visit but increased over time (-0.9 [interquartile range -1.1 to 0.1], -0.7 [-1.2 to 0.1], and -0.5 [-1.2 to 0]). Inverse correlations were found between BNP and IGF-1 at visit 1 (r=-0.40, p=0.097), BNP and IGF-1 and insulin-like growth factor-binding protein 3 at visit 2 (r=-0.33, p=0.080 and r=-0.33, p=0.085, respectively) and BNP and IGF-1 Zscore at visit 3 (r=-0.42, p=0.049). Significant relations were likewise found between the change in BNP and the change in IGF-1 between visits 1 and 3 (p=0.046) and between visits 2 and 3 (p=0.048). In conclusion, this pilot study demonstrates an inverse correlation between BNP and growth factors, suggesting that the heart failure state associated with this physiology may play a mechanistic role in impaired growth.

Relationship between noninvasive central blood pressure and brain natriuretic peptide levels in patients with hypertensive pulmonary edema.

Hypertensive pulmonary edema is a fatal condition unless early and properly diagnosed and managed. Central blood pressure (cBP) has been proven to be more associated with adverse cardiovascular events. We aimed to study the correlation between cBP and heart damage in patients with Hypertensive pulmonary edema. We included 50 patients admitted to the emergency department in a university hospital for hypertensive pulmonary edema, 27 women and 23 men aged 50 to 70 years. We excluded patients with suspected acute coronary syndrome, significant valvular heart disease, and pericardial diseases. We measured cBP non-invasively from pulse wave analysis of the brachial artery. Brain natriuretic peptide (BNP) and cBP were repeatedly measured for every patient. The median BNP levels of patients significantly decreased from 284 pg/ml (232-352.5) to 31.5 pg/ml (24-54) on discharge, P < 0.001. We found a significant correlation between admission BNP and central SBP (cSBP), urea, creatinine, arterial blood gases parameters, and left ventricular end-diastolic diameter (LVEDD). Concurrently, BNP at discharge was correlated with age, central DBP (cDBP), urea, creatinine, LVEDD, partial oxygen pressure (pO2), and oxygen saturation (SO2). Delta BNP was correlated with cSBP, peripheral SBP, urea, creatinine, pO2, and SO2. Linear regression analysis revealed that creatinine, and cSBP, were independent predictors of admission BNP, while urea and cDBP were the independent predictors of discharge BNP. This simple, noninvasive method of cBP measurement was significantly associated with the extent of myocardial damage in patients presenting with hypertensive pulmonary edema.

Abstract 11238: Impact of Baseline Heart Failure and Heart Failure Subtype on Brain Natriuretic Peptide Levels in Patients with Acute Pulmonary Embolism

Introduction: Among patients with acute pulmonary embolism (PE), elevated levels of brain natriuretic peptide (BNP) correlate with right ventricular dysfunction and increased morbidity and mortality. Suggested BNP cut-offs for PE risk stratification in the general population range from 90-100 pg/mL. It is unclear whether this BNP cut-off should be used for PE risk stratification among patients with heart failure (HF), who may have elevated BNP at baseline. Methods: Patients diagnosed with acute PE between 2010 and 2015 at the University of Toledo Medical Center were identified. Patients were categorized as: no HF, heart failure with reduced ejection fraction (HFrEF), or heart failure with preserved ejection fraction (HFpEF). No HF was defined as having no prior history of HF and an ejection fraction (EF) ≥ 50%. HFrEF was defined as history of HF and an EF &lt; 50%. HFpEF was defined as history of HF and an EF ≥ 50%. HF was defined as subjects with HFrEF or HFpEF. Results: One hundred and eighty-three patients with acute PE were identified for this study. One hundred and forty-two patients were classified as no HF (median BNP 112 [interquartile range (IQR) 49-355] pg/mL), while 41 were classified as HF (median BNP 422 [IQR 179-940] pg/mL) (p&lt;0.0001). When HF was further sub-categorized, we found significant differences in BNP levels between subjects with HFrEF (median BNP 923 [IQR 464-2296] pg/mL) vs. subjects with HFpEF (median BNP 247 [IQR 88-726] pg/mL) (p=0.002). Median BNP among patients with HFrEF was significantly higher compared to patients with no HF (p&lt;0.0001). Median BNP among patients with HFpEF was not significantly different compared to patients with no HF (p=0.416). Conclusions: Patients with HFrEF who present to the hospital with acute PE have significantly higher median BNP compared to patients with HFpEF or no HF. These results suggest that risk stratification for PE using current BNP cut-off guidelines may not be optimal for patients with HFrEF.

Lower heart rates and beta-blockers are associated with new-onset atrial fibrillation

Abstract Background Lower heart rates (HRs) prolong diastole, thereby raising filling pressures and wall stress (1,2), slowing myocardial relaxation (3), and increasing central blood pressure via superposition of reflected peripheral pressure waves onto systole (2,4). As a result, lower HRs may be associated with higher brain natriuretic peptide (BNP) levels and incident atrial fibrillation (AF). Beta-blockers (BBs) may thereby increase the risk for AF. Purpose Examine the relationships of HR, BNP, BB use and new-onset AF in the REVEAL-AF and SPRINT cohort of subjects at risk for developing AF. Methods In REVEAL-AF, 383 subjects (52% male, mean age 71.5±9.8 years) without a history of AF and a mean CHA2DS2VASC score of 4.4±1.3 received an insertable cardiac monitor and were followed up to 30 months. Baseline HRs were averaged between 8AM and 8PM for the first week post-implantation. Adjudicated AF lasting ≥6 minutes was defined as new-onset AF. In SPRINT, 7595 patients (64% male, mean age 67.5±9.2 years) without prior history of AF and a mean CHA2DS2VASC score of 2.3±1.2 were followed for up to 60 months. Baseline average HR was derived from three seated measurements taken at the initial clinical visit. 12-lead ECG at baseline, 2 years, 4 years and close-out visit were used to determine presence of AF. Based on longitudinal medication inventories BB use was categorized into “on BB” vs “never on BB” for the duration of the trial. Results The median daytime HR in the REVEAL-AF cohort was 75bpm [interquartile range, IQR 68–83]. Subjects with below median HRs had 2.4-fold higher BNP levels when compared to subjects with above median HRs (median BNP [IQR]: 62pg/dl [37–112] vs. 26pg/dl [13–53], p&amp;lt;0.001). Below median HRs were associated with a higher incidence of AF: 37% vs. 27%, p=0.047. This was validated in the SPRINT cohort after adjusting for AF risk factors (age, HR, sex, body mass index, coronary artery disease, intensive vs standard blood pressure therapy, chronic kidney disease). Both a HR&amp;lt;75bpm and BB use were independently associated with a higher rate of AF: 1.9 vs 0.7%, p&amp;lt;0.001 and 2.5% vs. 0.6%, p&amp;lt;0.001, respectively. The hazard ratio for patients on BB to develop AF was 3.72 [CI 2.32, 5.96], p&amp;lt;0.001. Conclusion Lower HRs and BB use are associated with higher BNP levels and incident AF, supporting the hypothesis that lower HRs mimic and/or exacerbate the hemodynamic effects of diastolic dysfunction and promote atrial myopathy. The effects of BBs on clinical outcomes in patient populations outside the context of heart failure with reduced ejection fraction will need to be reassessed. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health

Left Atrial Remodeling and Brain Natriuretic Peptide Levels Variation after Left Atrial Appendage Occlusion.

Background: Few data are available about brain natriuretic peptide (BNP) variation and left atrial remodeling after the left atrial appendage occlusion (LAAO) technique. Methods: Prospective study included all consecutive patients successfully implanted with an LAAO device. Contrast-enhanced cardiac computed tomography (CT) was performed before and 6 weeks after the procedure with reverse left atrial remodeling defined by an increase in LA volume >10%, together with blood sampling obtained before, 48 h after device implantation and at the first visit after discharge (30–45 days) for BNP measurement. Results: Among the 43 patients implanted with a complete dataset, mean end-diastolic LA volume was 139 ± 64 mL and 141 ± 62 mL at baseline and during follow-up (45 ± 15 days), respectively, showing no statistical difference (p = 0.45). No thrombus was seen on the atrial side of the device. Peridevice leaks (defined as presence of dye in the LAA beyond the device) were observed in 17 patients (40%) but were trivial or mild. Reverse atrial remodeling (RAR) at 6 weeks was observed in six patients (14%). Despite no difference in BNP levels on admission, median BNP levels at 48 h were slightly increased in RAR patients when compared with controls. During FU, BNP levels were strictly identical in both groups. These results were not modified even when each RAR case was matched with two controls on age, LVEF, creatinine levels and ACE inhibitors treatment to avoid potential confounders. Conclusion: Our study showed that despite the fact that the LAAO technique can induce left atrial remodeling measured by a CT scan, it does not seem to impact BNP levels on the follow-up. The results need to be transposed to clinical outcomes of this expanding population in future studies.

Value of Brain Natriuretic Peptide in Diagnosis and Control of Hyperthyroid Patients

Background:Brain natriuretic peptide (BNP) is released from the ventricular myocardium as a reaction to volume expansion and pressure overload. Since the thyroid hormones stimulate the release of BNP, it can be used as an indicator of thyroid failure and also guiding in thyroid control .So; this study was designed to assess the value of measuring serum BNP as a marker for diagnosis and follow up of patients with subclinical and overt hyperthyroidism. Patients and Methods: This is a prospective cohort study for patients with hyperthyroidism. Patients have been enrolled from Endocrinology Outpatient Clinic at Zagazig University Hospitals in the period from December 2018 to October 2020.Results: patients were divided into two major groups, overt hyperthyroidism (group 1) and subclinical hyperthyroidism (group 2).In all cases BNP level over 100 ng/l .Median for BNP in group (1) 671.89 and the median BNP in group (2 ) 318.19 .We noticed a significant elevation of BNP levels in group (1) than group (2) ( p =

Prognostic value of natriuretic peptides in heart failure: systematic review and meta-analysis

Risk models, informing optimal long-term medical management, seldom use natriuretic peptides (NP) in ascertaining the absolute risk of outcomes for HF patients. Individual studies evaluating the prognostic value of NPs in HF patients have reported varying effects, arriving at best estimates requires a systematic review. We systematically summarized the best evidence regarding the prognostic value of brain natriuretic peptide (BNP) and NT-proBNP in predicting mortality and hospitalizations in ambulatory heart failure (HF) patients. We searched bibliographic databases from 2005 to 2018 and included studies evaluating the association of BNP or NT-proBNP with mortality or hospitalization using multivariable Cox proportional hazard models. We pooled hazard ratios using random-effect models, explored heterogeneity using pre-specified subgroup analyses, and evaluated the certainty of evidence using the Grading of Recommendations and Development Evaluation framework. We identified 67 eligible studies reporting on 76,178 ambulatory HF patients with a median BNP of 407pg/mL (261-574pg/mL). Moderate to high-quality evidence showed that a 100-pg/mL increase in BNP was associated with a 14% increased hazard of mortality (HR 1.14, 95% CI 1.06-1.22); a 1-log-unit increase was associated with a 51% increased hazard of mortality (HR 1.51, 95% CI 1.41-1.61) and 48% increased hazard of mortality or hospitalization (HR 1.48, 95% CI 1.29-1.69). With moderate to high certainty, we observed a 14% independent relative increase in mortality, translating to a clinically meaningful increase in absolute risk even for low-risk patients. The observed associations may help in developing more accurate risk models that incorporate NPs and accurately prognosticate HF patients.