N-terminal Fragment Of Pro-brain Natriuretic Peptide Research Articles

Outcome of Transcatheter Aortic Valve Replacement for Pure Native Aortic Regurgitation in Patients with Pulmonary Hypertension.

In recent years, transcatheter aortic valve replacement (TAVR) has emerged as a pivotal treatment for pure native aortic regurgitation (PNAR). Given patients with severe aortic regurgitation (AR) are prone to suffer from pulmonary hypertension (PH), understanding TAVR's efficacy in this context is crucial. This study aims to explore the short-term prognosis of TAVR in PNAR patients with concurrent PH. Patients with PNAR undergoing TAVR at Zhongshan Hospital, Affiliated with Fudan University, were enrolled between June 2018 to June 2023. They were categorized based on pulmonary artery systolic pressure (PASP) into groups with or without PH. The baseline characteristics, imaging records, and follow-up data were collected. Among the 103 patients recruited, 48 were afflicted with PH. In comparison to PNAR patients without PH, the PH group exhibited higher rates of renal dysfunction (10.4% vs. 0.0%, p = 0.014), increased Society of Thoracic Surgeons scores (6.4 1.9 vs. 4.7 1.6, p 0.001), and elevated Nterminal fragment of pro-brain natriuretic peptide (NT-proBNP). Transthoracic ultrasound examination revealed that patients with PH displayed lower left ventricular ejection fraction, larger left ventricle dimension, and more frequent moderate to severe tcuspid regurgitation (TR). Following TAVR, both groups experienced significant reductions in PASP, mitral regurgitation (MR) and TR. There were no significant differences in the incidence of postoperative adverse events in patients with or without PH. We found TAVR to be a safe and effective treatment for patients with PNAR and PH, reducing the degree of aortic regurgitation and PH without increasing the risk of postoperative adverse events.

ARTERIAL HYPOTENSION IN HEART FAILURE PATIENTS INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS

HighlightsArterial hypotension is a factor aggravating the course of heart failure in HIV-infected people in 18.3% of cases, more often accompanied by the development of left ventricular hypertrophy. The risk factor for the development of arterial hypotension in persons infected with the human immunodeficiency virus (HIV) and having HF is the concentration of caspase-6 in the blood serum, which probably indicates the intensification of apoptosis processes in cardiomyocytes. The value of the glomerular filtration rate, calculated by the CKD-EPI formula with the inclusion of the level of cystatin C in the blood serum, is associated with the development of arterial hypotension. AbstractAim. To study the features of arterial hypotension in HIV-infected patients with HF in comparison with patients with normal blood pressure.Methods. The study included 44 patients with arterial hypotension (AHT) and 76 patients with normal blood pressure (BP) with heart failure (HF) and HIV admitted to a multidisciplinary hospital. All patients underwent the same number of examinations conducted personally by the author: echocardiography, noninvasive arteriography, assessment of the severity of HF using the Clinical Status Assessment Scale by V. Yu. Mareeva, six-minute walk test. Additionally, studies such as the determination of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP), cystatin C, caspase-6 and lipocaine 2 (NGAl) were conducted in a laboratory.Results. HIV-infected patients with HF are prone to developing AHT in 18.3% of cases. The results of the study indicate the predominance of males with low body mass index and high alcohol consumption in the group of patients with AHT. Moreover, patients with AHT are more likely to have pericardial effusion in front of the anterior wall of the right ventricle greater than 5 mm, anemia, unsuppressed viral load, left ventricular diastolic dysfunction and hypertrophy. At the same time, the level of cystatin C in their blood serum is lower, and the glomerular filtration rate is higher than in patients without AHT. The level of caspase-6 in the blood serum was significantly higher in the group of patients with AHT.Conclusion. HIV-infected patients with HF are prone to developing AHT in 18.3% of cases. The results of the study indicate a significant predominance of patients with LVH in the group of patients with AHT. The concentration of caspase-6 in blood serum equal to 148.35 pg/mL and higher turned out to be a risk factor for the development of AHT in HIV-infected patients with HF, probably indicating an intensification of apoptosis processes in cardiomyocytes. A glomerular filtration rate (GFR) equal to 47.5 mL/min/1.73 m2 and higher, calculated using the CKD-EPI formula with the inclusion of the level of cystatin C in the blood serum, is associated with a high probability of developing AHT. The pattern obtained may indicate both the activation of apoptosis processes against the background of AHT in the cells of the heart muscle, and the preservation of GFR against this background in patients with HF and HIV infection.

Risk stratification and response to therapy in patients with pulmonary arterial hypertension and comorbidities: A COMPERA analysis.

A diagnosis of idiopathic pulmonary arterial hypertension (IPAH) is frequently made in elderly patients who present with comorbidities, especially hypertension, coronary heart disease, diabetes mellitus, and obesity. It is unknown to what extent the presence of these comorbidities affects the response to PAH therapies and whether risk stratification predicts outcome in patients with comorbidities. We assessed the database of COMPERA, a European pulmonary hypertension registry, to determine changes after initiation of PAH therapy in WHO functional class (FC), 6-minute walking distance (6MWD), brain natriuretic peptide (BNP) or N-terminal fragment of probrain natriuretic peptide (NT-pro-BNP), and mortality risk assessed by a 4-strata model in patients with IPAH and no comorbidities, 1-2 comorbidities and 3-4 comorbidities. The analysis was based on 1,120 IPAH patients (n=208 [19%] without comorbidities, n=641 [57%] with 1-2 comorbidities, and n=271 [24%] with 3-4 comorbidities). Improvements in FC, 6MWD, BNP/NT-pro-BNP, and mortality risk from baseline to first follow-up were significantly larger in patients with no comorbidities than in patients with comorbidities, while they were not significantly different in patients with 1-2 and 3-4 comorbidities. The 4-strata risk tool predicted survival in patients without comorbidities as well as in patients with 1-2 or 3-4 comorbidities. Our data suggest that patients with IPAH and comorbidities benefit from PAH medication with improvements in FC, 6MWD, BNP/NT-pro-BNP, and mortality risk, albeit to a lesser extent than patients without comorbidities. The 4-strata risk tool predicted outcome in patients with IPAH irrespective of the presence of comorbidities.

Prognostic value of improvement endpoints in pulmonary arterial hypertension trials: A COMPERA analysis.

The prognostic value of improvement endpoints that have been used in clinical trials of treatments for pulmonary arterial hypertension (PAH) needs to be further investigated. Using the COMPERA database, we evaluated the prognostic value of improvements in functional class (FC) and absolute or relative improvements in 6-min walking distance (6MWD) and N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP). In addition, we investigated multicomponent endpoints based on prespecified improvements in FC, 6MWD and NT-proBNP that have been used in recent PAH trials. Finally, we assessed the predictive value of improvements determined by risk stratification tools. The effects of changes from baseline to first follow-up (3-12 months after initiation of PAH therapy) on consecutive survival were determined by Kaplan-Meier analysis with Log-Rank testing and Cox proportional hazard analyses. All analyses were based on 596 patients with newly diagnosed PAH for whom complete data were available at baseline and first follow-up. Improvements in FC were associated with improved survival, whereas absolute or relative improvements in 6MWD had no predictive value. For NT-proBNP, absolute declines conferred no prognostic information while relative declines by ≥35% were associated with better survival. Improvements in multicomponent endpoints were associated with improved survival and the same was found for risk stratification tools. While sole improvements in 6MWD and NT-proBNP had minor prognostic relevance, improvements in multicomponent endpoints and risk stratification tools based on FC, 6MWD, and NT-proBNP were associated with improved survival. These tools should be further explored as outcome measures in PAH trials.

Association of sex hormone dynamics with 10-year survival in men with implanted cardiac resynchronization therapy devices

Aim. To assess association of different dynamics of sex hormones with 10-year survival in men with congestive heart failure (CHF) and implanted cardiac resynchronization therapy (CRT) devices.Methods. Based on tercile of testosterone at the end of the study (TESend), 157 men with CRT (mean age 58.7±9.7 years old; 95 men (60.5%) w/ ischemic CHF) were divided into 3 groups: gr. I (n=52) - TESend<13.3 nmol/l; gr. II (n=53) - TESend>13.3<19.2 nmol/l; gr. III (n=52) - TESend>19.2 nmol/l. Parameters of echocardiography (Echo) were investigated in dynamics, N-terminal fragment of probrain natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), total and free testosterone (TES), estradiol (E2), sex hormone-binding globulin (SHBG), progesterone (PGN), dehydroepiandrosterone sulfate (DHEAS), E2/TES ratio were tested in plasma. Survival in groups was assessed using Kaplan-Meier method.Results. Groups were comparable in age, presence of ischemic CHF, arterial hypertension and surgeries on myocardial revascularization. Higher incidence of atrial fibrillation, obesity, complete left bundle branch block, tendency to higher incidence of diabetes mellitus and higher body mass index was revealed in gr. I compared to gr. III. At baseline, groups didn’t differ in Echo parameters; the highest TES levels were found in gr. III. After CRT, there was less reverse cardiac remodeling, decrease of TES level (p<0.001) in gr. I vs increase of TES level in gr. II (p=0.041) and gr. III (<0.001); E2 level increased (p=0.008), levels of NT-proBNP and IL-6 decreased only in gr. III. In absence of dynamics of E2/TES index and DHEAS level in groups, E2/TES index was the highest and DHEAS level was the lowest in gr. I after CRT. 10-year survival of groups was 17.6%, 42.8%, 46.2% (Log Rank test I-II=0.016; Log Rank test I-III=0.004; Log Rank test II-III=0.528).Conclusion. Obtained results indicated different dynamics of sex steroids after CRT. Sex hormones variation pattern, interrelated with increase in levels of testosterone, estradiol, dehydroepiandrosterone sulfate and decrease in testosterone to estradiol ratio, was associated with better 10-year survival in men with implantable CRT devices with greater reverse cardiac remodeling and reduction in activity of systemic immune inflammation.

Risk Assessment after ST-Segment Elevation Myocardial Infarction: Can Biomarkers Improve the Performance of Clinical Variables?

Introduction: Myocardial infarction with ST-segment elevation (STEMI) is the coronary artery disease associated with the highest risk of morbimortality; however, this risk is heterogeneous, usually being evaluated by clinical scores. Risk assessment is a key factor in personalized clinical management of patients with this disease. Aim: The aim of this study was to assess whether some new cardiac biomarkers considered alone, combined in a multibiomarker model or in association with clinical variables, improve the short- and long-term risk stratification of STEMI patients. Materials and Methods: This was a retrospective observational study of 253 patients with STEMI. Blood samples were obtained before or during the angiography. The assessed biomarkers were C-terminal fragment of insulin-like growth factor binding protein-4 (CT-IGFBP4), high sensitive cardiac troponin T (hs-cTnT), N-terminal fragment of probrain natriuretic peptide (NT-proBNP), and growth differentiation factor 15 (GDF-15); they reflect different cardiovascular (CV) physiopathological pathways and underlying pathologies. We registered in-hospital and follow-up mortalities and their causes (cardiovascular and all-cause) and major adverse cardiac events (MACE) during a two year follow-up. Discrimination, survival analysis, model calibration, and reclassification of the biomarkers were comprehensively evaluated. Results and Discussion: In total, 55 patients (21.7%) died, 33 in-hospital and 22 during the follow-up, most of them (69.1%) from CV causes; 37 MACE occurred during follow-up. Biomarkers showed good prognostic ability to predict mortality, alone and combined with the multibiomarker model. A predictive clinical model based on age, Killip–Kimball class, estimated glomerular filtration rate (eGFR), and heart rate was derived by multivariate analysis. GDF-15 and NT-proBNP significantly improved risk assessment of the clinical model, as shown by discrimination, calibration, and reclassification of all the end-points except for all-cause mortality. The combination of NT-proBNP and hs-cTnT improved CV mortality prediction. Conclusions: GDF-15 and NT-proBNP added value to the usual risk assessment of STEMI patients.

Childhood Trauma in Patients With PAH-Prevalence, Impact on QoL, and Mental Health-A Preliminary Report.

Background/ObjectiveChild maltreatment is associated with increased risk of psychological consequences, contributes to morbidity and has long lasting effects on mental health and quality of life. Child maltreatment has not been assessed in patients with pulmonary arterial hypertension (PAH). We examined the prevalence of child maltreatment and determined their impact on disease severity in patients with PAH.MethodsA cross-sectional observational multicenter study at two PH centers in Germany was conducted. Patients with a confirmed diagnosis of PAH were given a self-administered questionnaire. Child maltreatment using the Childhood Trauma Questionnaire (CTQ), quality of life (QoL), anxiety, depression, and lifestyle factors were assessed and enhanced by clinical parameters 6-min walk distance (6MWD), WHO functional class (WHO FC), and serum levels of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP). Prevalence rates of child maltreatment were compared to the general population and impact of child maltreatment on disease severity was calculated by logistic regression analysis.ResultsTwo-hundred and seventeen patients, 71% female and a median age of 56 years were enrolled in this study. Patients with PAH had higher rates of emotional abuse and lower rates of physical neglect compared to the German population while rates of emotional neglect, physical abuse, and sexual abuse did not differ between patients and German population. Patients with any form of child maltreatment were more likely to be active smokers, had a worse QoL and more anxiety or depression. Moderate associations between child maltreatment, mental health, QoL, lifestyle factors and clinical parameters could be observed. Logistic regression analysis showed a significant impact of CTQ-total score on disease severity with an OR of 1.022 (95%-CI: 1.001–1.042, p = 0.035).ConclusionWe found a higher rate of child maltreatment in patients with PAH in comparison to the German population. Correlations suggest moderate associations between CTQ-scores and mental health as well as QoL. Child maltreatment had significant impact on disease severity. However, effects were moderate. We conclude that child maltreatment has effects on mental health and quality of life in patients with PAH and may have limited effect on disease severity.

Low Free Triiodothyronine Level as a Predictor of Cardiovascular Events and All-Cause Mortality in Patients Undergoing Hemodialysis: The DREAM Cohort.

Aim: Low T3 syndrome is characterized by low serum triiodothyronine (T3) levels without elevation of thyroid-stimulating hormone (TSH) in patients without apparent thyroid disease, which is known to be associated with worse clinical outcomes in various populations including those with kidney failure. In this study, we examined whether low free T3 (FT3) levels are independent predictor of cardiovascular disease (CVD) events in patients undergoing hemodialysis. Methods: This was a prospective cohort study of patients with chronic kidney disease undergoing hemodialysis. From the total of 518 patients, we excluded patients with treated or untreated hyperthyroidism or hypothyroidism and those treated with corticosteroids. Results: We analyzed data from 438 eligible patients. During the 5-year follow-up, 154 new CVD events and 86 all-cause deaths were recorded. Kaplan-Meier analysis showed that lower FT3 levels were associated with higher risks for new cardiovascular events and all-cause death. This inverse association of FT3 and new CVD events remained significant after adjustment for age, sex, duration of hemodialysis, diabetic kidney disease, hypertension, dyslipidemia, and smoking; however, it was no longer significant after further adjustment for prior CVD or N-terminal fragment of probrain natriuretic peptide (NT-proBNP). FT3 did not show an independent association with all-cause mortality. Conclusions: Our results indicate that low FT3 status is not an independent predictor of new CVD events and that the following factors are closely associated: prior CVD, low FT3 and high NT-proBNP levels at present, and future risk of new CVD events in hemodialysis patients.

P1209ROLE OF NTPROBNP IN LONG-TERM PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims Plasma N-terminal fragment of pro brain natriuretic peptide (NTproBNP) concentration is elevated in cardiovascular diseases such as congestive heart failure, where increased levels of NTproBNP indicate cardiac dysfunction, hypervolemia, and higher risk of hospitalization and death. These associations have also been studied in patients with chronic kidney disease (CKD), where NTproBNP value remains controversial, especially in long-term peritoneal dialysis (PD) patients with respect to its pathophysiologic implications. This study aim was to determine whether NTproBNP was a predictor of hospital admissions and cardiovascular events among patients on automated (APD) and continuous (CAPD) ambulatory peritoneal dialysis. Methods This was a cross-sectional study which included stable patients from two Peritoneal Dialysis Units. Plasma NTproBNP concentration was measured in stable adult peritoneal dialysis patients attending for routine assessments on PD outpatient clinic. In all patients, demographic variables, clinical and other laboratory parameters were recorded and analyzed. Descriptive statistics was performed. Groups were compared using independent t-test for comparison of continuous variables and Chi square test for categorical variables. In order to evaluate relationship between NTproBNP and the other variables multivariate logistic regression and Pearson bivariate analysis were used. Results The study enrolled 70 patients (male/female 44/26; mean age 55.3±14.6 years; APD/CAPD 25/45; PD duration 28±24.2months). One third (31.4%) of the patients was diabetic, 12.9% presented cardiac insufficiency and 20% had cardiovascular disease. Pearson bivariate correlation analysis revealed that patients with higher weekly kt/v (p=0.039), total fluid removal (diuresis and ultrafiltration) (p=0.027) and total weekly creatinine clearance (p=0.007) had lower NTproBNP values. These patients had also significant lower plasmatic creatinine and phosphorus levels. We found no significant association with residual kidney function, peritoneal transport (D/P creatinine), serum albumin levels and c-reactive protein. We also found that patients with higher NTproBNP levels had significantly more cardiovascular events (p=0.010) and a trend for more common hospital admissions (p=0.066). There were no significant differences regarding NTproBNP between the two modalities of peritoneal dialysis (APD and CAPD patients) or in patients who were PD first. As expected, patients with cardiac dysfunction had significant higher NTproBNP values (p=0.004). Diabetic patients had higher NTproBNP levels, althought this difference was not significant. Conclusion Despite the inconsistency in the NTproBNP value among long-term PD patients, results from most studies concur that NTproBNP levels are closely associated with left ventricular dysfunction, morbidity and mortality in these patients. In our study, patients with higher NTproBNP levels had more cardiovascular events and a trend for more common hospital admissions. Regular monitoring of NTproBNP levels among PD patients may be useful for providing care for these patients. Plus, NTproBNP was associated with better PD efficacy, greater fluid removal and higher creatinine clearance, reinforcing clinical relevance of PD optimization. These results require confirmation in a prospective study.

4283Exercise right heart catheterization before and after balloon pulmonary angioplasty in inoperable patients with chronic thromboembolic pulmonary hypertension

Abstract Background Balloon pulmonary angioplasty (BPA) is an evolving treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). The main indicator for success is improvement in pulmonary hemodynamics, but outcome data are heterogeneous. Purpose The aim of the present study was to evaluate pulmonary hemodynamics not only at rest, but also during exercise before and 6 months after BPA. Methods We report a prospective series of 64 consecutive patients with inoperable CTEPH who were treated interventionally with BPA. All patients underwent standardized assessment prior to the first BPA and 6 months after the last intervention. Assessment included WHO FC, Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR), 6-minute walking distance (6MWD), serum levels of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP), and exercise RHC. Results The mean number of sessions per patient was 5.6 (± 1.3) and the mean number of pulmonary segments targeted in all interventions was 11 (± 3). BPA treatment led to improvements in pulmonary hemodynamics and exercise capacity (6MWD: 416±94 m vs. 463±96 m; p<0.0001) except for CO and CI during RHC at rest; these parameters showed improvements only during exercise RHC. MPAP at rest showed a reduction from 41±9 to 31±9 mmHg (p<0.0001) and PVR at rest decreased from 6.8±2.3 WU to 4.3±1.9 WU (p<0.0001). Further decreases were observed for systolic pulmonary arterial pressure, TPG, PVR, and TPR. Cardiac output (7.0±2.0 L/min vs. 8.3±2.0 L/min; p<0.0001) and cardiac index during exercise RHC (3.8±1.1 L/min/m2 vs. 4.4±1.1 L/min/m2; p<0.0001) improved significantly. Median NT-proBNP concentrations decreased from 741 ng/L (IQR 192–1425 ng/L) to 139 ng/L (IQR 60–266 ng/L) during BPA treatment (p<0.0001). Results from the CAMPHOR questionnaire showed significant improvements in symptoms (11±5.8 vs. 5.5±4.9, p<0.0001), activity limitations (9.2±5.6 vs. 5.2±4.5, p<0.0001), and quality of life (6.4±5.7 vs. 3.5±3.7, p<0.0001). Conclusion Significant improvements in pulmonary hemodynamics at rest and during exercise were observed 6 months after BPA. Exercise right heart catheterization offers a more discriminating evaluation of the changes in pulmonary hemodynamics after BPA.

Combination of left ventricular reverse remodeling and brain natriuretic peptide level at one year after cardiac resynchronization therapy predicts long-term clinical outcome

IntroductionThe aim of this study was to investigate the predictors of long-term clinical outcome of heart failure (HF) patients who survived first year after initiation of cardiac resynchronization therapy (CRT).MethodsThis was a single-center observational cohort study of CRT patients implanted because of symptomatic HF with reduced ejection fraction between 2005 and 2013. Left ventricle (LV) diameters and ejection fraction, New York Heart Association (NYHA) class, and level of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) were assessed at baseline and 12 months after CRT implantation. Their predictive power for long-term HF hospitalization and mortality, and cardiac and all-cause mortality was investigated.ResultsA total of 315 patients with left bundle branch block or intraventricular conduction delay who survived >1 year after CRT implantation were analyzed in the current study. During a follow-up period of 4.8±2.1 years from CRT implantation, 35.2% patients died from cardiac (19.3%) or non-cardiac (15.9%) causes. Post-CRT LV ejection fraction and LV end-systolic diameter (either 12-month value or the change from baseline) were equally predictive for clinical events. For NT-proBNP, however, the 12-month level was a stronger predictor than the change from baseline. Both reverse LV remodeling and 12-month level of NT-proBNP were independent and comparable predictors of CRT-related clinical outcome, while NT-proBNP response had the strongest association with all-cause mortality. When post-CRT relative change of LV end-systolic diameter and 12-month level of NT-proBNP (dichotomized at -12.3% and 1230 ng/L, respectively) were combined, subgroups of very-high and very-low risk patients were identified.ConclusionThe level of NT-proBNP and reverse LV remodeling at one year after CRT are independent and complementary predictors of future clinical events. Their combination may help to improve the risk stratification of CRT patients.

A. Diagnostic and prognostic value of detection of the N-terminal fragment of brain natriuretic peptide in type 2 diabetes mellitus

Detction of chronic heart failure at the stage of reversible changes can prevent the development of cardiovascular complications, reduce morbidity and mortality in patients with type 2 diabetes mellitus. The aim of our study was to explore the level of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) and to evaluate the possibility of using this marker in diagnostics of chronic heart failure in patients with type 2 diabetes. The study included 60 patients with type 2 diabetes and concomitant chronic heart failure. All patients underwent echocardiography, blood glucose and glycated hemoglobin, creatinine, and NT-proBNP measurement. All patients with diabetes mellitus were shown to have elevated NT-proBNP levels in comparison with the control group. We established negative correlation of this parameter with the left ventricular ejection fraction and inverse correlation between NT-proBNP and blood glucose. The study confirmed the value of NT-proBNP measurement for diagnostics of CHF but demonstrated low specificity of this test for the assessment of severity (functional class) of CHF in patients with type 2 diabetes.

Predicting the outcome of hip fracture patients by using N-terminal fragment of pro-B-type natriuretic peptide

ObjectiveTo examine the prognostic value of perioperative N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in hip fracture patients.DesignBlinded prospective cohort study.SettingSingle centre trial at Turku University Hospital in Finland.ParticipantsInclusion criterion...

Vasoactive Peptide Levels after Change of Dialysis Mode

Background/Aims: Plasma concentrations of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) are increased in end-stage renal disease. Improvement in hemodynamic stability has been reported when switching from hemodialysis (HD) to on-line hemodiafiltration (ol-HDF). The aim of this study was to investigate plasma concentrations of NT-proBNP, BNP and neuropeptide Y (NPY) during a 1-year follow-up, after a change from high-flux HD to postdilution ol-HDF. Additional variables were also studied, e.g. pulse wave velocity and ordinary clinical parameters. Method: We conducted a prospective, single-center study including 35 patients who were switched from HD to HDF. Plasma concentrations of NT-proBNP, BNP and NPY before and after dialysis were measured at baseline (i.e. HD) and at 1, 2, 4, 6 and 12 months on HDF. Results: All three peptide levels decreased significantly during HD and HDF when comparing concentrations before and after dialysis. Mean absolute value (before/after) and relative decrease (%) before versus after dialysis was 13.697/9.497 ng/l (31%) for NT-proBNP, 62/40 ng/ml (35%) for BNP and 664/364 pg/l (45%) for NPY. No significant differences were observed when comparing predialysis values over time. However, postdialysis NT-proBNP concentration showed a significant decrease of 48% over time after the switch to HDF. Conclusion: The postdialysis plasma levels of NT-proBNP, BNP and NPY decreased significantly during both dialysis modes when compared to before dialysis. The postdialysis lowering of NT-proBNP increased further over time after the switch to ol-HDF; the predialysis levels were unchanged, suggesting no effect on its production in the ventricles of the heart.

N-terminal fragment of probrain natriuretic peptide is associated with diabetes microvascular complications in type 2 diabetes.

Aim/introductionCirculating levels of N-terminal fragment of probrain natriuretic peptide (NT-proBNP) are established as a risk factor for cardiovascular disease and mortality in patients with diabetes, as well as in the general population. We sought to examine the possibility of NT-proBNP as a biomarker of microvascular complications in patients with type 2 diabetes.Materials and methodsIn total, 277 outpatients with type 2 diabetes were consecutively enrolled as a hospital cohort. Two hundred and seventeen of these patients (132 males; mean age, 63.4 years) were designated as cases with any of the diabetic complications (retinopathy, neuropathy, nephropathy, ischemic heart disease, strokes, peripheral artery disease), and 60 (42 males; mean age, 54.1 years) were set as controls without clinical evidence of diabetic complications. Diabetic complications were evaluated by medical record and routine laboratory examinations. NT-proBNP was measured and investigated with regard to the associations with diabetic complications.ResultsMean NT-proBNP levels were significantly higher in patients with any of the diabetic complications (59 versus 33 pg/mL; P<0.0001). In logistic regression analysis, NT-proBNP levels >79 pg/mL, which was the highest tertile, were independently associated with a 5.04 fold increased risk of all complications (P<0.0051) compared to the lowest tertile (NT-proBNP levels <31 pg/mL). Odd ratios of cardiovascular disease and nephropathy, neuropathy, and retinopathy were 9.33, 6.23, 6.6 and 13.78 respectively, in patients with NT-proBNP values in the highest tertile (>79 pg/mL), independently of age, sex, duration of diabetes or other risk factors, such as body mass index or hemoglobin A1c. In addition, NT-proBNP levels were associated with surrogate markers of atherosclerosis, such as brachial-ankle pulse wave velocity (r=0.449, P<0.0001) and left ventricular hypertrophy (r=0.212, P<0.001).ConclusionIn this hospital-based cohort of type 2 diabetes, the NT-proBNP levels were associated with systemic atherosclerosis and comorbid diabetic microvascular as well as macrovascular complications. It is useful to stratify high-risk diabetic patients by measuring NT-proBNP and to start comprehensive care for preventing the progression of diabetic complications. It is necessary to elucidate the underlying mechanism for the progression of diabetic complications represented by an elevation of NT-proBNP and to demonstrate the ability of NT-proBNP as a predictive global biomarker for diabetic complications in Japanese type 2 diabetic patients.

Comparison of NT-proBNP levels in hemodialysis versus peritoneal dialysis patients

Plasma N-terminal fragment of pro brain natriuretic peptide (NT-proBNP) concentration is elevated in cardiovascular diseases such as congestive heart failure, where increased levels of NT-proBNP indicate cardiac dysfunction, hypervolemia, and higher risk of hospitalization and death. These associations apply also to patients with severe impairment of kidney function. Little is known about diferences in plasma level of NT-proBNP in patients receiving hemodialysis (HD) versus those receiving continuous ambulatory peritoneal dialysis (CAPD). To evaluate differences in plasma NT-proBNP concentration between HD and CAPD patients. Plasma NT-proBNP concentration was prospectively measured in consecutive patients receiving either HD or CAPD at our hospital center. All other standard clinical parameters were recorded. The correlation between plasma NT-proBNP concentration and the type of dialysis was then examined. We studied 99 consecutive patients on HD (age 62 ± 15 years, 66% male) and 18 consecutive patients on CAPD (age 56 ± 18 years, 67% male). Both groups had similar baseline characteristics including duration of dialysis, left ventricular function and mass, and cardiothoracic ratio. Significantly more patients on HD had abnormal NT-proBNP levels compared to patients on CAPD (97% vs 44%; P<0.0001), and this difference remained highly significant when using various NT-proBNP cut off values. A subgroup analysis revealed that the lower NT-proBNP levels of CAPD patients are most pronounced in patients with preserved left ventricular ejection function. As expected, NT-proBNP levels correlated negatively with left ventricular function and positively with cardiothoracic ratio, and this applied to both HD and CAPD groups. The lower concentration of NT-proBNP in patients on CAPD compared to those on HD suggests that CAPD produces lesser hemodynamic stress, especially in patients with preserved left ventricular systolic function. Even though increased NT-proBNP levels have been shown to predict increased morbidity and mortality, further studies are necessary to assess the long term benefit of CAPD compared to HD.

Acute and long-term effect of infliximab on humoral and echocardiographic parameters in patients with chronic inflammatory diseases

Tumor necrosis factor alpha (TNF-alpha) plays an important role in the pathogenesis of chronic inflammatory diseases, i.e., rheumatoid arthritis (RA), ankylosing spondylitis (AS), Crohn's disease (CD), and ulcerative colitis (UC). Anti-TNF-alpha strategies are successfully used in their treatment. However, their effect on heart function is still uncertain. The objectives of the study were to examine the acute and long-term effect of infliximab on the heart morphology and function in patients with chronic inflammatory disorders. Thirty-one patients (21 men and 10 women) were included. Ten percent of them were diagnosed with RA, 22.5% with AS, 22.5% with CD, and 45% with UC, respectively. N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) was measured before and immediately after infliximab administration at the beginning of the study and in the sixth and 12th months. Echocardiography was performed at baseline and in the sixth and 12th months. There was a significant increase in NT-proBNP after the first infliximab infusion (88.40 ± 14.09 vs. 95.24 ± 14.28pg/ml, p = 0.0046) and similar response was detected after each infusion in the sixth and 12th months. Plasma NT-proBNP slightly but not significantly decreased (88.40 ± 14.09 vs. 81.74 ± 23.14pg/ml, p = 0.583, and 88.40 ± 14.09 vs. 56.83 ± 17.77pg/ml, p = 0.0576, in the sixth and 12th months, respectively). There were no significant changes in echocardiographic structural and functional parameters of the left ventricle during follow-up. Plasma NT-proBNP mildly but significantly increases immediately after infliximab infusion. However, long-term infliximab administration does not deteriorate both cardiac morphology and function.

N-TproBNP as Biomarker in Systemic Sclerosis

Systemic sclerosis (SSc) is a connective tissue disorder characterized by tissue fibrosis affecting the skin and internal organs, fibroproliferative vasculopathy, and autoimmune activation. SSc still heralds a poor prognosis with significant morbidity and mortality. Early detection of organ involvement is critical as currently available treatments are most effective when started early. Many candidate biomarkers have been investigated in the past two decades. However, despite the enormous efforts, no accurate tool to predict the pattern of organ involvement and to assess disease activity has been yet identified. The N-terminal fragment of probrain natriuretic peptide (N-TproBNP) is a neurohormone released by ventricular myocytes in response to pressure overload. N-TproBNP is highly relevant for diagnosis, prognosis, and prediction of pulmonary arterial hypertension in SSc. Moreover, several studies support its potential benefit for cardiac assessment of scleroderma patients. Conversely, the role of N-TproBNP as surrogate marker of pulmonary fibrosis and skin involvement is much less clear. We provide an extensive review of the studies that have previously investigated the role of N-TproBNP as candidate biomarker in scleroderma manifestations, presenting also the findings of a recent study we conducted in a cohort of 87 SSc patients.

Prognostic Value of NT-proBNP at Rest and Peak Exercise in Patients With Impaired Left Ventricular Function

We aimed to identify whether N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) at peak exercise can provide incremental clinical information over resting levels. A total of 90 patients with systolic heart failure were prospectively studied. Levels of plasma NT-proBNP were assessed at rest and at peak exercise during a cardiopulmonary exercise test. Patients were followed-up for 30 ± 10 months. Levels of NT-proBNP at baseline and peak exercise were significantly correlated with left ventricular ejection fraction ([LVEF] r = -.629, P < .001 and r = -.630, P < .001, respectively) and peak oxygen uptake ([Vo (2)] r = -.752, P < .001 and r = -.740, P < .001, respectively). Levels of plasma NT-proBNP at peak exercise demonstrated similar predictive ability for the detection of patients with low peak Vo (2) and LVEF <28%. Levels of plasma NT-proBNP can detect low-functional class patients and patients who may be the candidates for heart transplantation with high sensitivity and specificity. At baseline and peak exercise, NT-proBNP demonstrates similar prognostic and predictive ability.

Predictive value of serum NT-proBNP levels in type 2 diabetic people with diabetic nephropathy

ObjectiveThe serum N-terminal fragment of pro brain natriuretic peptide (NT-proBNP) level in type 2 diabetic subjects with or without diabetic nephropathy (DN) is still unclear. We aimed to evaluate the relationship between serum NT-proBNP levels and different stages of diabetic nephropathy, and identify probable factors predicting serum NT-proBNP level. Subjects and methodsThis cross-sectional study included 20 normoalbuminuric (Group-I), 28 microalbuminuric (Group-II), 20 macroalbuminuric type 2 diabetic patients (Group-III), and 20 healthy volunteers (Group-IV). Serum NT-proBNP levels were measured with highly sensitive and specific immunoassay. ResultsMean NT-proBNP levels were 32±55, 91±95, 331±297, 42±34pg/ml for Groups I–IV, respectively. When patients with LVH were excluded, mean logNT-proBNP was still significantly higher in Group-III than all other groups. The three diabetic groups were similar in age, BMI, HbA1c, fasting serum glucose, and GFR. In a multivariate linear regression model, adjusting for factors significantly correlated with NT-proBNP levels, the patient group, presence of LVH, and hemoglobin remained as an independent predictor of serum NT-proBNP. These variables explained 68% of the variability of NT-proBNP (adjusted R2=0.683). ConclusionsMean serum NT-proBNP level of macroalbuminuric diabetic patients was higher than normoalbuminuric and microalbuminuric diabetic patients, and healthy control subjects even after exclusion of LVH. NT-proBNP may be a useful and predictive marker of diabetic nephropathy.