N-terminal B-type Natriuretic Peptide Research Articles

Serum uric acid: A risk factor for right ventricular dysfunction and prognosis in heart failure with preserved ejection fraction.

Hyperuricemia and right ventricular dysfunction (RVD) are both widespread in heart failure with preserved ejection fraction (HFpEF) patients. RVD is associated with a poor prognosis in HFpEF. The correlation between serum uric acid (UA) levels and right ventricular function is unclear. The prognostic performance of UA in patients with HFpEF needs further validation. A total of 210 patients with HFpEF were included in the study and divided into two groups according to UA level: the normal UA group (≤7 mg/dl) and the high UA group (>7 mg/dl). The variables examined included clinical characteristics, echocardiography, and serum biochemical parameters. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular peak systolic velocity (TAPSV). Baseline characteristics were compared between the two groups, and the correlation between baseline UA and RVD was assessed using multifactorial binary logistic regression. Kaplan-Meier curves were used to describe all-cause mortality and heart failure readmission. Results showed that right ventricular function parameters were worse in the high UA group. After adjusting for UA, left ventricular posterior wall thickness (LVPWT), N-terminal B-type natriuretic peptide (NT-proBNP), atrial fibrillation (AF), and low-density lipoprotein cholesterol (LDL-C), UA (odds ratio = 2.028; p < 0.001) was independently associated with RVD, and UA >7 mg/dl (HR = 2.98; p < 0.001) was associated with heart failure readmission in patients with HFpEF. Elevated serum UA is closely associated with RVD and significantly associated with the heart failure readmission rate in patients with HFpEF.

Risk factors for inspiratory muscle weakness in coronary heart disease

BackgroundPatients with coronary heart disease (CHD) are susceptible to lung function problems caused by respiratory muscle weakness. Many CHD patients show complications of respiratory muscle weakness, but the risk factors remain unclear. ObjectiveTo explore the risk factors for inspiratory muscle weakness in CHD. MethodsThis study enrolled 249 patients with CHD who underwent maximal inspiratory pressure (MIP) measurement between April 2021 and March 2022.According to the percentage of MIP (MIP/Predicted normal value [PNV]), patients were divided into the inspiratory muscle weakness (IMW) (n = 149) (MIP/PNV<70%) and control groups (n = 100) (MIP/PNV≥70༅). Clinical information and MIP of the two groups were collected and analyzed. ResultsThe incidence of IMW was 59.8% (n = 149). Age (P < 0.001); history of heart failure (P < 0.001), hypertension (P = 0.04), and peripheral artery disease (PAD) (P = 0.001); left ventricular end-systolic dimension (P = 0.035); presence of segmental motion abnormality of the ventricular wall (P = 0.030); and high density lipoprotein cholesterol (P = 0.001) and N-terminal brain natriuretic peptide (NT-proBNP) levels (P < 0.001) in the IMW group were significantly higher than those in the control group. The proportion of anatomic complete revascularization (P = 0.009), left ventricular ejection fraction (P = 0.010), and alanine transaminase (P = 0.014) and triglycerides levels (P = 0.014) in the IMW group were significantly lower than those in the control group. Logistic regression analysis showed that anatomic complete revascularization (OR=0.350, 95%CI 0.157–0.781) and NT-proBNP level (OR=1.002, 95%CI 1.000–1.004) were independent risk factors for IMW. ConclusionThe independent risk factors for decreased IMW in patients with CAD were anatomic incomplete revascularization and NT-proBNP level.

Clinical Utility of N-Terminal Prohormone B-Type Natriuretic Peptide Levels in Patients of Type 2 Diabetes Mellitus with Heart Failure

Objective: To evaluate the effect of type 2 diabetes mellitus on plasma N-terminal prohormone B-type natriuretic peptide levels in patients with heart failure and correlate it with glycosylated haemoglobin levels.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Department of Chemical Pathology in collaboration with the Department of Cardiology,Combined Military Hospital, Multan Pakistan, from Feb to Sep 2021.&#x0D; Methodology: We assayed plasma NT-pro BNP levels in 194 individuals with established heart failure, (98 non-diabetics, and 96 patients with diabetes). Plasma NT-pro BNP levels were compared between groups in addition, the correlation of glycosylated haemoglobin with plasma NT-pro BNP levels was explored.&#x0D; Results: The mean plasma NT-pro BNP values were higher in patients with diabetes (15826.08 ±8143.434pg/mL) than in nondiabetics (12534.06±6323.92pg/mL) with a p-value 0.02. When NT-pro BNP was compared there was no significant found difference between the non-diabetic group and the Controlled Diabetes-Group (p-value 0 .882), but it was significantly higher in the Uncontrolled Diabetes-Group (p-value&lt;0.001). A moderate positive association was found between NT-pro BNP and glycosylated haemoglobin (r=0.541, p-value&lt;0.001).&#x0D; Conclusion: Although obesity has an inverse relation with plasma natriuretic peptides level and most patients with diabetes are overweight, the plasma NT-pro BNP is still a very informative tool and holds its significance as a diagnostic and prognosis marker in diabetic patients with heart failure.

Correlation of Mean Heart Dose and Cardiac Biomarkers with Electrocardiographic Changes in Patients Receiving Thoracic Radiation Therapy.

Cardiotoxicity is a well-recognized, serious adverse effect of thoracic radiation therapy. This study aimed to evaluate longitudinal electrocardiogram (ECG) changes in patients receiving thoracic radiation therapy and identify correlating factors that can predict the risk of cardiotoxicity. This retrospective study included 202 patients treated with thoracic radiation therapy, and chemotherapy and targeted therapy were allowed. Mean heart dose (MHD) was evaluated on dose-volume histograms. ECG, high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal B-type natriuretic peptide (NT-proBNP) analyses were conducted before irradiation and during the follow-up period of 6-12 months (average 8 months). Chi square test and logistic regression analysis were applied to identify risk factors associated with ECG changes. At a median time of 3 months postirradiation, 46.5% of patients showed ECG changes, and 33.0% of patients achieved baseline ECG levels during the follow-up period at a median of 5 months postirradiation. Logistic regression analysis identified MHD, hs-cTnT and NT-pro BNP as significant factors associated with ECG changes (P < 0.05). Hs-cTnT and NT-proBNP were increased significantly after radiation therapy compared with baseline levels (P < 0.05), and these increases were observed as a median time of 2 months postirradiation, which was earlier than ECG changes. Higher MHD and elevated hs-cTnT and NT-proBNP levels correlated with an increased risk of ECG changes in patients receiving thoracic radiation therapy. Early identification of patients at high risk of cardiotoxicity and timely intervention might reduce the incidence of radiation-induced cardiac toxicity.

Association of Long-term Change in N-Terminal Pro–B-Type Natriuretic Peptide With Incident Heart Failure and Death

Most studies, especially in primary prevention patients, have evaluated N-terminal B-type natriuretic peptide (NT-proBNP) at one time point. Evaluation of change in NT-proBNP may improve risk stratification for incident cardiovascular events. To assess the association between change in NT-proBNP and risk for incident heart failure (HF) and death. Participants were recruited from 4 US communities enrolled in the Atherosclerosis Risk in Community (ARIC) study. Individuals who attended ARIC visits 2 and 4 (approximately 6 years apart) with measurements of NT-proBNP and without prevalent HF were included. Assays of NT-proBNP were conducted between 2011 and 2013, and analysis took place between July 2021 and October 2022. The primary exposure variable was NT-proBNP change between visits 2 and 4, modeled as change categories (<125 pg/mL or ≥125 pg/mL) and as percent change. The primary outcome measures were incident HF hospitalization and all-cause death. The association between changes in cardiovascular risk factors with change in NT-proBNP was further assessed. A total of 9776 individuals (mean [SD] age, 57.1 [5.7] years at visit 2; 5523 [56.5%] women) were included in the study. Compared with participants with NT-proBNP level less than 125 pg/mL at both visits, participants with NT-proBNP level of 125 pg/mL or higher at both visits had an increase in incident HF (adjusted hazard ratio [HR], 2.40 [95% CI, 2.00-2.88]) and mortality risk (HR, 1.68 [95% CI, 1.47-1.91). Participants with NT-proBNP levels of 125 pg/mL or higher at visit 2 and less than 125 pg/mL at visit 4 had similar risk for HF and death (HR, 1.01 [95% CI, 0.71-1.43]; HR, 0.79 [95% CI, 0.61-1.01]) compared with the group with NT-proBNP levels of less than 125 pg/mL at both visits. The percent change in NT-proBNP was positively associated with HF and death (HR, 1.06 [95% CI, 1.02-1.10]; HR, 1.05 [95% CI, 1.03-1.08] per 1-SD increase, respectively). Change in systolic blood pressure, low-density lipoprotein cholesterol, triglyceride level, body mass index, and estimated glomerular filtration rate were significantly associated with change in NT-proBNP. In this study, 6-year change in NT-proBNP reflected dynamic change in risk for HF events and death among community-dwelling adults without prevalent clinical HF. These results support the utility of serial NT-proBNP measurements to improve risk stratification of patients with pre-HF.

Elevated serum FGF21 levels predict heart failure during hospitalization of STEMI patients after emergency percutaneous coronary intervention.

Fibroblast growth factor 21 (FGF21) has multiple cardioprotective effects including modulation of glucolipid metabolism, anti-inflammation, and anti-oxidative stress, but its association with the heart failure during hospitalization in patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI) has not been reported. A total of 348 STEMI patients treated with emergency PCI were included from January 2016 to December 2018. Relevant biochemical indicators were measured by central laboratory. Serum FGF21 levels were measured by ELISA. The occurrence of heart failure during hospitalization was recorded. Patients' cardiac function was assessed by echocardiography. Serum FGF21 levels were significantly higher in the STEMI group with heart failure than in the group without heart failure (249.95 ± 25.52 vs. 209.98 ± 36.35, P < 0.001). Serum FGF21 levels showed a strong positive correlation with N-terminal precursor B-type natriuretic peptide (NT-proBNP) in STEMI patients (r = 0.749, P < 0.001). FGF21 was found to be an independent risk factor for the development of heart failure during hospitalization in STEMI patients by binary logistic regression analysis. The area under curve (AUC) for FGF21 to predict the development of heart failure during hospitalization in STEMI patients was 0.816 (95% CI [0.770-0.863]) according to the receiver operating characteristic (ROC) curve analysis. Elevated serum FGF21 levels have been shown to be a strong predictor of heart failure during hospitalization in patients with STEMI after emergency PCI.

The clinical significance of circulating glucose-regulated protein 78, Caspase-3, and C/EBP homologous protein levels in patients with heart failure

Background and aimsThe destruction of endoplasmic reticulum (ER) homeostasis leads to heart failure (HF), which further aggravates ER stress. Limited data are available on the levels of ER stress markers in HF patients in clinical practice. This study aimed to determine the clinical significance of the ER stress markers, glucose-regulated protein 78 (GRP78), Caspase-3, and C/EBP homologous protein (CHOP), in predicting HF and its severity. Materials and methodsA total of 62 patients with HF and 44 healthy controls were enrolled in the study, and all participants were followed-up for 2 years. ResultsSerum GRP78, Caspase-3, and CHOP levels were significantly higher in patients with HF than those in healthy controls. The level of GRP78 increased with the severity of HF. GRP78 levels were negatively correlated with left ventricular ejection fraction, and positively correlated with N-terminal B-type natriuretic peptide, D-dimer, and lactic acid. Serum GRP78 and Caspase-3 levels showed moderate predictive values for HF patients. ConclusionER stress markers, GRP78 and Caspase-3, had a certain predictive value in HF and can be used as serum biomarkers for the diagnosis of HF. Additionally, GRP78 showed a certain predictive value in HF severity.

Effect of Emergency Percutaneous Coronary Intervention Combined with Sacubitril and Valsartan on the Cardiac Prognosis in Patients with Acute Myocardial Infarction.

This study aimed to investigate the effect of emergency percutaneous coronary intervention (PCI) combined with sacubitril-valsartan (Entresto) on the cardiac prognosis in patients with acute myocardial infarction (AMI). A total of 78 AMI patients who were treated in our hospital between January 2020 and September 2021 were included and randomly divided into treatment group and control group (n=39 per group). In the control group, patients were treated with primary PCI combined with irbesartan; in the treatment group, patients were treated with primary PCI combined with Entresto; pharmacotherapy lasted for 3 months. The left ventricular remodeling indexes, serum N-terminal B-type natriuretic peptide precursor (NT-proBNP), serum homocysteine (HCY), cystatin C (CysC) and results of 6-minute walk test (6MWT) before and after treatment were compared between two groups. The incidence of major adverse cardiovascular events (MACE) was determined and compared between them. (1) Before treatment, there were no marked differences in the left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness (IVST), NT-proBNP, left ventricular ejection fraction (LVEF), HCY, CysC, and results of 6MWT between two groups (P>0.05). After treatment, the LVEDS, LVEDD, NT-proBNP, HCY and CysC in the control group were significantly higher than in the treatment group (P<0.05). The recovery of LVEF and 6MWT in the treatment group was significantly better than in the control group (P<0.05). After treatment, there was no significant difference in the IVST between two groups (P>0.05). (2) The incidence of MACE in the control group was significantly higher than in the treatment group (P<0.05). Compared with irbesartan, Entresto can further improve the cardiac function, prevent ventricular remodeling, and further optimize the clinical efficacy of PCI in AMI patients.

Electrocardiographic Time-Intervals Waveforms as Potential Predictors for Severe Acute Kidney Injury in Critically Ill Patients.

Acute kidney injury (AKI) is common in critically ill patients admitted to intensive care units (ICU) and is frequently associated with poorer outcomes. Hence, if an indicator is available for predicting severe AKI within the first few hours of admission, management strategies can be put into place to improve outcomes. This was a prospective, observational study, involving 63 critically ill patients, that aimed to explore the diagnostic accuracy of different Doppler parameters in predicting AKI in critically ill patients from a mixed ICU. Participants were enrolled at ICU admission. All underwent ultrasonographic examinations and hemodynamic assessment. Renal Doppler resistive index (RDRI), venous impedance index (VII), arterial systolic time intervals (a-STI), and venous systolic time intervals (v-STI) were measured within 2 h from ICU admission. Cox proportional hazards models, including a-STI, v-STI, VII, and RDRI as independent variables, returned a-STI as the only putative predictor for the development of AKI or severe AKI. An overall statistically significant difference (p &lt; 0.001) was observed in the Kaplan-Meier plots for cumulative AKI events between patients with a-STI higher or equal than 0.37 and for cumulative severe AKI-3 between patients with a-STI higher or equal than 0.63. As assessed by the area under the receiver operating curves (ROC) curves, a-STI performed best in diagnosing any AKI and/or severe AKI-3. Positive correlations were found between a-STI and the N-terminal brain natriuretic peptide precursor (NT-pro BNP) (ρ = 0.442, p &lt; 0.001), the sequential organ failure assessment (SOFA) score (ρ: 0.361, p = 0.004), and baseline serum creatinine (ρ: 0.529, p &lt; 0.001). Critically ill patients who developed AKI had statistically significant different a-STI (on admission to ICU), v-STI, and VII than those who did not. Moreover, a-STI was associated with the development of AKI at day 5 and provided the best diagnostic accuracy for the diagnosis of any AKI or severe AKI compared with RDRI, VII, and v-STI.

Bosentan Is Associated with a Reduction in Right Ventricular Systolic Pressure N-Terminal Pro-Hormone B-Type Natriuretic Peptide Levels in Young Patients with Pulmonary Hypertension

Pulmonary hypertension is a rare and potentially fatal disease in children if left untreated. Emerging therapies, including Bosentan, a dual endothelin receptor antagonist, have shown significant benefits in the adult pulmonary hypertension population; however, few studies have assessed the efficacy and safety of endothelin receptor antagonists in infants and young children. Our study was a single-center retrospective analysis of patients less than two years of age with a confirmed diagnosis of pulmonary hypertension and initiated on Bosentan therapy between 2017 and 2020. Twelve cases met eligibility criteria. Demographic data, laboratory data, echocardiographic, and cardiac catheterization data were analyzed. With treatment, there was a statistically significant decrease in mean right ventricular systolic pressure estimated by the tricuspid regurgitation jet (79 ± 23 mmHg reduced to 52 ± 25 mmHg; p < 0.001) N-terminal pro-hormone B-type natriuretic peptide levels (21,071 reduced to 2,037; p < 0.001). Additionally, improvement and eventual normalization of right ventricular function and septal geometry was seen within the first four months of therapy. Patients who underwent cardiac catheterization after therapy initiation (n = 4) demonstrated hemodynamic improvements; however, only the decrease in diastolic pulmonary artery pressure was statistically significant (p = 0.018). No significant differences in hemoglobin, platelet count, or liver function tests were observed between groups. In conclusion, these data suggest that Bosentan may be an effective and relatively safe treatment option for children less than two years of age with pulmonary hypertension. Further long-term randomized control studies are necessary to validate the potential clinical benefit of utilizing this drug therapy in young children.

The carbohydrate-deficient transferrin as a marker of chronic alcohol consumption and assessment of its usefulness in patients with cardiovascular diseases – a pilot study

Abstract Introduction Cardiovascular diseases (CVDs) are the leading cause of death in the world. The dose of 60 g of alcohol / day has been estimated to significantly increase the risk of developing high blood pressure, arrhythmias, hemorrhagic stroke, and cardiomyopathy. The aim of the study was to evaluate the diagnostic value of CDT when compared with gammaglutamyltransferase (GGT), alkaline phosphatase (ALP), N-terminal fragment brain natriuretic peptide (NT pro-BNP) and troponin T biomarkers in patients with heart failure. Materials and Methods The study was conducted on 59 patients with advanced heart failure with reduced ejection fraction (EF&lt;40%). CDT serum levels were measured using CDT kit, Chromsystems Instruments &amp; Chemicals GmbH, Germany and were expressed as a percentage of total transferrin using high-performance liquid chromatography (HPLC). Results Nineteen patients (n = 19) expressed a normal level of carbohydrate deficiency transferrin &lt;1.2% of the total transferrin found in plasma. The results are obtained from 34 patients (n = 34) were within the range doubtful for the test (1.2–2.5%). In 6 Patients (n = 6) the results of more than 2.5% of CDT content were observed, which could indicate chronic alcohol consumption. Conclusions No statistically significant correlations between CDT and troponin T or NT pro-BNP were identified.

Shape dependency of gold nanorods through TMB2+-mediated etching for the visual detection of NT-proBNP.

Heart failure (HF) is a major public health problem triggered by heart circulation disorders. Early detection and diagnosis are conducive to the prevention and treatment of HF. Hence, it is necessary to establish a simple and sensitive method to monitor the diagnostic biomarkers of HF. The N-terminal B-type natriuretic peptide precursor (NT-proBNP) is acknowledged as a sensitive biomarker. In this study, a visual detection method for NT-proBNP was developed based on the oxidized 3,3',5,5'-tetramethylbenzidine (TMB2+)-mediated etching of gold nanorods (AuNRs) and double-antibody-sandwich ELISA. The etching color for different amounts of NT-proBNP was obvious and significant differences could be ascertained based on the blue-shift of the longitudinal localized surface plasmon resonance (LLSPR) of the AuNRs. The results could be observed by the naked eye. The constructed system showed a concentration range from 6 to 100 ng mL-1 and a low detection limit of 6 ng mL-1. This method exhibited negligible cross-reactivity toward other proteins, and the recoveries of the samples ranged from 79.99% to 88.99%. These results demonstrated that the established method is suitable for the simple and convenient detection of NT-proBNP.

NT-proBNP increase during stress echocardiography predicts significant changes in ischemic mitral regurgitation severity in patients qualified for surgical revascularization.

In many patients, significant changes in ischemic mitral regurgitation (IMR) severity during exercise can be observed independent of the degree of IMR at rest. This study aimed to investigate the correlations between N-terminal fragment B-type natriuretic peptide (NT-proBNP) and echocardiography measurements at rest and at peak exercise in patients with moderate IMR who qualified for surgical revascularization. A total of 100 patients eligible for coronary artery bypass grafting, were included in this prospective study. All patients underwent exercise echocardiography. Additionally, the levels of NT-proBNP were measured at rest and after peak exercise. A positive correlation of absolute NT-proBNP levels with effective regurgitant orifice area (EROA) were observed and with tricuspid regurgitant peak gradient (TRPG) at peak exercise. Absolute ΔNT-proBNP during exercise and the tenting area at rest were independent predictors of severe IMR at peak exercise. The level of absolute ΔNT-proBNP during exercise and coaptation height at rest were the most important predictors of significant increases in TRPG. The best cutoff value for ΔNT-proBNP as a predictor for increases in EROA at peak exercise was 68.9 pg/mL and to predict an increase in TRPG ≥ 50 mmHg at peak exercise was 68 pg/mL. The level of ΔNT-proBNP during exercise was the most important parameter in predicting significant changes in IMR severity and pulmonary pressure. Based on the present data, it can be speculated that integration of the assessment of NT-proBNP at rest and at exercise might improve patient selection for valve surgery.

Prognostic value of N-terminal pro-form B-type natriuretic peptide (NT-proBNP) in patients with congenital heart disease undergoing cardiac surgery: a systematic review and meta-analysis of cohort studies.

To perform an updated and comprehensive meta-analysis on the prognostic value of N-terminal pro-form B-type natriuretic peptide (NT-proBNP) in patients with congenital heart disease (CHD) undergoing cardiac surgery. A systematic search was conducted until September 2021 for relevant studies published in PubMed, Web of Science Database and Embase. Based on the average values, NT-proBNP concentrations were classified as high and low levels. The outcomes of interest were mortality, cardiovascular events, and other postoperative outcomes. A random-effects model was used to calculate composite risk estimates and corresponding 95% confidence intervals (CIs). Possible sources of heterogeneity and stability of results were analyzed using subgroup and sensitivity analyses. A total of 32 studies published between 2008 and 2021 involving 7,571 participants were included. Results showed CHD patients at high NT-proBNP levels yielded an increased risk of mortality [risk ratio (RR) =1.14; 95% CI: 1.08-1.20] and cardiovascular events (RR =2.02; 95% CI: 1.26-3.24) compared with those at low NT-proBNP levels. No significant association was found between NT-proBNP and risks for other postoperative outcomes in CHD patients undergoing cardiac surgery (RR =1.73; 95% CI: 0.86-3.47). Significant heterogeneity was detected across studies regarding these risk estimates. Subgroup analysis found heterogeneity in the risk estimate of mortality was explained by geographic region, type of CHD, and assay method of NT-proBNP. Sensitivity analysis supported the robustness of results. Compared with CHD patients at low NT-proBNP levels, CHD patients at high NT-proBNP levels had elevated risks of mortality and cardiovascular events. Further large-scale and well-controlled studies are needed to confirm our findings.

Clinical Presentation of Myocarditis in Children Visiting Dr Ruth KM PFAU, Civil Hospital, Karachi. A Cross-Sectional Study

Objective: To determine the frequency of various clinical presentations of myocarditis in children visiting to Dr Ruth KM PFAU, Civil Hospital Karachi. Study design: Cross-Sectional Study. Place and duration: Department of Pediatric Medicine, Dr Ruth K.M PFAU Civil Hospital, Karachi, Pakistan from September, 2020, to March, 2021 Methodology: The study covered all patients who visited Karachi's Civil Hospital and met the inclusion criteria. After describing the study's process, hazards, and benefits, informed consent was obtained. The initial ECG, echocardiography, and cardiac enzyme readings were all documented. Stroke, congenital heart disease, sepsis, asthma, pulmonary embolism, cardiomyopathy, gastroenteritis, diabetes mellitus, and renal failure were among the clinical presentations that were noted. The proforma that is supplied at the end was filled out with all the acquired data and used electronically for research. Results: Age was 6.8± 2.1 years on average. A total of 238 (67.6%) of the 352 patients were male, and 114 (32.4%) were female. In patients with myocarditis who presented clinically, renal disease was found in 46 (13.1%), cardiomyopathy in 30, congenital heart disease in 56 (15.9%), stroke in 41 (11.5%), gastroenteritis in 65 (18.5%), diabetes mellitus in 19 (5.4%), sepsis in 32 (9.2%), and asthma in 48 (13.6%) patients, while pulmonary embolism was found in 15 (4.3%) patients. Practical implication There is growing evidence to support the use of tests such as cardiac magnetic resonance imaging and serum N-terminal B-type natriuretic peptide measurements as supplements to clinical diagnosis. These could eventually lessen the need for invasive procedures like endomyocardial biopsy, which is still the gold standard. Conclusion: The most frequent clinical manifestation of myocarditis was gastroenteritis, which was followed by congenital heart disease and asthma. For the purpose of validating the results so far, additional extensive research is advised. Keywords: Clinical Presentation, Myocarditis, Epidemiology, Asthma, Gastroenteritis

Impact of NLR on atrial fibrillation recurrence after radiofrequency ablation in atrial fibrillation patients combined with heart failure

Objective: To investigate the predictive value of neutrophils-to-lymphocytes ratio (NLR) for atrial fibrillation recurrence after radiofrequency ablation in atrial fibrillation patients combined with heart failure. Methods: This is a retrospective cohort study. Patients with atrial fibrillation and heart failure who received radiofrequency ablation in the First Affiliated Hospital of Zhengzhou University from January 2019 to June 2020 were included. Patient were followed up in the outpatient clinic at 3, 6, 9 and 12 months after radiofrequency ablation and were divided into recurrent and non-recurrent groups according to the absence or presence of atrial fibrillation. Demographic data, echocardiographic indices and inflammation-related indices including NLR were collected and compared between the two groups. Spearman rank correlation was performed to analyze the correlation of NLR with atrial fibrillation recurrence after radiofrequency ablation. Multivariate logistic regression analysis was used to determine independent risk factors of atrial fibrillation recurrence after radiofrequency ablation. The receiver operating characteristic (ROC) curve was used to evaluate the value of NLR in predicting the atrial fibrillation recurrence after radiofrequency ablation. Results: A total of 883 patients were included, of which 460 (52.1%) were male, mean age was (64.4±10.7) years old. There were 246 patients (27.9%) in the recurrence group and 637 patients (72.1%) in the non-recurrence group. Compared with the non-recurrent group, the duration of atrial fibrillation, NLR, neutrophil count, N-terminal B-type natriuretic peptide precursor (NT-proBNP) and body mass index levels were significantly higher, while lymphocyte count was significantly lower in the recurrence group than in the non-recurrent group (all P<0.05). Spearman rank correlation analysis showed that NLR was positively correlated with the atrial fibrillation recurrence (r=0.333, P<0.05). Multivariate logistic regression analysis showed that NLR was an independent risk factor for atrial fibrillation recurrence after radiofrequency ablation in atrial fibrillation patients combined heart failure (OR=1.634, P<0.001). The ROC curve showed that the area under the curve (AUC) of NLR in predicting the recurrence of atrial fibrillation after radiofrequency ablation was 0.715 (95%CI: 0.668-0.762, P<0.001), with a sensitivity of 55.61% and a specificity of 84.54%. Conclusion: NLR is a useful predictor of atrial fibrillation recurrence after radiofrequency ablation in atrial fibrillation patients combined with heart failure.

One-Step Photochemical Immobilization of Aptamer on Graphene for Label-Free Detection of NT-proBNP

A novel photochemical technological route for one-step functionalization of a graphene surface with an azide-modified DNA aptamer for biomarkers is developed. The methodology is demonstrated for the functionalization of a DNA aptamer for an N-terminal B-type natriuretic peptide (NT-proBNP) heart failure biomarker on the surface of a graphene channel within a system based on a liquid-gated graphene field effect transistor (GFET). The limit of detection (LOD) of the aptamer-functionalized sensor is 0.01 pg/mL with short response time (75 s) for clinically relevant concentrations of the cardiac biomarker, which could be of relevance for point-of-care (POC) applications. The novel methodology could be applicable for the development of different graphene-based biosensors for fast, stable, real-time, and highly sensitive detection of disease markers.

Abstract 14691: Sex Differences in the Prognostic Value of N-Terminal Brain Natriuretic Peptide in Pulmonary Arterial Hypertension

Introduction: Pulmonary arterial hypertension (PAH) causes right heart failure (HF) and mainly affects females, but males have worse survival. Atrial Natriuretic Peptide (ANP) and Brain Natriuretic Peptide (BNP), along with N-terminal BNP (NTproBNP), are secreted from cardiomyocytes upon stretch and are important biomarkers in HF. Sex differences are observed in NTproBNP levels and prognostic value in left HF, but unknown in right HF. The aim was to assess sex differences in NTproBNP levels and prognostic value in PAH from a translational perspective. Methods: We screened patients with baseline NTproBNP measurements and right heart catheterization between 2002 and 2020. Induced pluripotent stem cells (iPSCs) from 1 male and 1 female PAH-patients were differentiated into cardiomyocytes (iPSC-CMs), and stretched for 24h at 1Hz and 10% on the Flexcell FX-6000 system (N=2). Gene expression analyses were performed on static and stretched samples. Results: 266 patients (N=106 male, N=166 female) were included. Median baseline NTproBNP levels were similar in male and female patients (1118 vs 832 ng/ml, P=0.58). We risk stratified patients on NTproBNP according to the guidelines and assessed differences in 1-year survival. In males highest 1-year mortality was observed in low and low-intermediate risk groups (16,4% and 7.7%, respectively) vs females (4.7% and 4.2%, respectively) (Figure1 A,B). Preliminary results indicate ~2x higher BNP mRNA expressions on male vs female patients (0.80 vs 0.37, N=3 male and N=3 female, P=0.018), after mechanical stretch (Figure1 C). Conclusions: Although no sex differences were observed in NTproBNP plasma levels, it had different prognostic value in male and female patients. Furthermore, in vitro male iPSC-CMs had higher BNP levels after stretch compared to female iPSC-CMs.

Cardiac function in bronchiolitis: Not only a right ventricle matter.

Extrapulmonary manifestations of bronchiolitis have been previously studied, with some identifying right ventricle (RV) diastolic/systolic dysfunction. We hypothesized that severe cases of bronchiolitis would have cardiac dysfunction resulting an increase in N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) values and worse outcomes. Therefore, the objective was to evaluate the existence of cardiac dysfunction and to determine its association with severe bronchiolitis. This prospective cohort study included children hospitalized for bronchiolitis under 1-yearold between January 2019 and March 2020. At admission, an echocardiography was performed and plasma levels of NT-proBNP were measured. To analyze outcomes, the cohort was divided into two groups based on the need for positive pressure respiratory support (PPRS), and both were compared to healthy infants. bivariant analysis, significant differences p < 0.05. One hundred eighty-one patients were included; median age was 2 months. Seventy-three patients required PPRS. Compared to controls, patients requiring PPRS showed worse RV systolic function, with lower tricuspid annular-plane systolic excursion (p = 0.002) and parameters of worse right and left diastolic function (trans-tricuspid E and A wave [p = 0.004 and p = 0.04, respectively] and tricuspid tissue doppler imaging [TDI] e' [p = 0.003], trans-mitral E and mitral TDI a' [p = 0.02 and p = 0.005, respectively]). AnNT-ProBNP greater than 3582 pg/dl predicts the need for longer necessity of PPRS in patients younger than 2 months. In addition to the expected RV systolic dysfunction, patients with severe bronchiolitis have parameters of global diastolic worse function possibly secondary to intrinsic myocardial involvement. NT-ProBNP values at admission had strong discriminatory power to predict worse outcomes.

Detection of soluble suppression of tumorigenicity 2 and N-terminal B-type natriuretic peptide in a rat model of aortic regurgitation: differential responses to omecamtiv mecarbil.

Both N-terminal fragment of B-type natriuretic peptide (NT-proBNP) and soluble isoform of ST2 (sST2) have been identified as biomarkers of heart failure. We evaluated the plasma levels of NT-proBNP and sST2 in a rat model of severe aortic valve regurgitation (AR) and correlated these findings with echocardiographic measurements. We also examined the impact of omecamtiv mecarbil (OM) on these parameters. The plasma levels of NT-proBNP and sST2 were measured in 18 rats both before and 2months after surgical induction of AR, and at these same time points, in six rats assigned to a sham-procedure control group. Plasma biomarkers were then measured again after infusion of OM or placebo in rats with AR (n=8 and 10, respectively) and OM alone in the sham control rats (n=6). Echocardiographic measurements were collected before and 2months after induction of AR. Our results revealed increased levels of plasma NT-proBNP (219±34pg/mL vs. 429±374pg/mL; p<0.001) in rats with AR at day 7 after infusion of placebo, whereas plasma levels of sST2 were higher in this cohort after infusion of either OM or placebo. We identified a significant positive correlation between plasma sST2 with posterior wall thickness in diastole (r=0.34, p<0.05) and total body weight (r=0.45, p<0.01) in rats with surgically induced AR. Because sST2 increased markedly, whereas NT-proBNP remained unchanged, when OM was administered, we hypothesize that sST2 has a distinct capability to detect deleterious effects of passive muscle tension, not reliably assessed by NT-proBNP, in the setting of AR.