N-terminal Pro-brain-type Natriuretic Peptide Levels Research Articles

A Systematic Review of NT-proBNP as Prognostic Biomarker for Preeclampsia Complications

Background: Preeclampsia can lead to maternal and fetal complications due to its ability to cause multiple organ disorders. Interestingly, N-terminal pro-brain-type natriuretic peptide (NT-proBNP) levels were higher in preeclampsia than in non-preeclampsia, representing cardiovascular mal¬function as the potential cause. Moreover, NT-proBNP also has a potential role in predicting complications that will arise in preeclampsia. This systematic review was performed to determine the role of NT-proBNP plasma levels in predicting maternal and fetal complications in preeclampsia.Subjects and Method: This systematic review was conducted based on PRISMA-P by previous observational study from scientific databases, namely Hinari, Cochrane Library, ScienceDirect, Scopus, and grey literature in OCLC’s OAISTER between 2006 and 2021. The search keyword used were ((NTproBNP) OR (NT-proBNP) OR (N-terminal pro-BNP) OR (N-terminal pro-Brain Natriuretic Peptide)) AND ((preeclampsia) OR (pre-eclampsia)) AND (pregnancy complications). Newcastle - Ottawa Quality Assessment Scale (NOS) was used to assess quality of included studies.Results: After study selection, five studies from 156 studies were considered eligible and selected in this systematic review. The results showed that pre-eclampsia complications occurred with NT-proBNP levels above 500 mg/dL, which cardiovascular complications may occurred above 700 mg/dL. NT-proBNP levels were higher in women with maternal complications such as placental abruption, HELLP (Hemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, eclampsia, pulmonary oedema, congestive heart failure, cerebrovascular accident, renal dysfunction, and hypertensive retinopathy. Furthermore, increased NT-proBNP levels were associated with fetal growth restriction, resulting in low birth weight. NT-proBNP was significantly higher in pregnant women due to a combination of pre-existing volume overload and NT-proBNP clearance dysfunction in kidney. Conclusion: NT-proBNP levels were associated with adverse outcomes in preeclampsia. NT-proBNP serum levels could be used to predict maternal-fetal complications in preeclampsia. Keywords: preeclampsia, fetal, maternal, complications, NT-proBNP Correspondence: Aiman Hilmi Asaduddin. Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. E-mail: aimanhilmi02@student.uns.ac.id. Phone number: +62 85726562060.

NT-proBNP-Possible Prognostic Marker in Pregnant Patients with Associated Cardiovascular Risk Factors and SARS-CoV-2 Infection.

N-terminal pro brain-type natriuretic peptide (NT-proBNP) is a practical biomarker in the clinical pathologies where the ventricle is under stress and particularly stretched in the general population. The study aims to compare the value of NT-proBNP and its importance in the prognosis and severity of the cases involving pregnant patients with SARS-CoV-2 infection and cardiovascular risk factors to those of low-risk pregnant patients, mainly by analysing their symptoms, administered medication, days of hospitalization and severity of the viral disease. The study included a total of eighty-three pregnant patients who underwent natural birth or caesarean section at out hospital. NT-proBNP levels were analyzed at hospital admission as a potential cardiovascular marker. A comparative analysis was performed between pregnant patients with cardiovascular risk factors and pregnant patients without cardiovascular risk factors regarding NT-proBNP values. Pregnant patients with SARS-CoV-2 infection and cardiovascular risk factors had higher values of NT-proBNP in comparison to pregnant patients without cardiovascular risk factors. NT-proBNP testing in pregnant patients with SARS-CoV-2 infection can be a relatively important marker to be taken into consideration when it comes to the management, treatment and outcome of the cases, especially when it comes to women with associated cardiovascular risk factors.

Racial and ethnic differences in circulating N-terminal pro-brain-type natriuretic peptide (NT-proBNP) in US adults

BackgroundThe presence and interpretation of racial and ethnic differences in circulating N-terminal pro-brain-type natriuretic peptide (NT-proBNP), a diagnostic biomarker for heart failure, are controversial. ObjectiveTo examine racial and ethnic differences in NT-proBNP levels among the general US adult population. MethodsWe performed a cross-sectional analysis of data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES). We included 4717 non-Hispanic White, 1675 non-Hispanic Black, and 2148 Mexican American adults aged 20 years or older without a history of cardiovascular disease. We examined the associations of race and ethnicity with NT-proBNP using linear and logistic regression models in the overall population and in a younger, ‘healthy’ subsample. ResultsThe mean age was 45 years. Median NT-proBNP levels were significantly lower among Black (29.3 pg/mL) and Mexican American adults (28.3.4 pg/mL) compared to White adults (49.1pg/mL, P-values<0.001). After adjusting for sociodemographic factors and cardiovascular risk factors, NT-proBNP was 34.4% lower (95%CI -39.2 to -29.3%) in Black adults and 22.8% lower (95%CI -29.4 to -15.5) in Mexican American adults compared to White adults. Our findings were consistent in a young, healthy subsample, suggesting non-cardiometabolic determinants of these differences. ConclusionsNT-proBNP levels are significantly lower among Black and Mexican American adults compared with White adults, independent of cardiometabolic risk. Although race/ethnicity is a poor proxy for genetic differences, our findings may have clinical implications for the management of HF. However, studies in diverse populations are needed to characterize the biological basis of NT-proBNP variation.

Assessment of Relationship between Serum NT-proBNP Levels with Clinical Features and Prognosis in Acute Ischemic Stroke Patients.

We aimed to assess N-terminal pro brain-type natriuretic peptide (NT-proBNP) levels in acute ischemic stroke (AIS) patients according to clinical and radiological features and to investigate its relationship with short term clinical outcomes. In our study, 107 patients with AIS were evaluated prospectively. Of all, 56 patients had no evidence of atrial fibrillation (AF) (sinus rhythm [SR] group) (52.3%), 24 patients had paroxysmal AF (pAF group) (22.4%), and the other 27 patients had chronic AF (cAF group) (25.3%). Demographic datas, clinical characteristics, laboratory and radiological findings, CHA2DS2 -VASc scores, NIHSS (National Institute of Health Stroke Scale) and modified Rankin Scale (mRS) scores on admission and at the third month evaluations were recorded. Good functional outcome at 3 months was defined as modified Rankin score (mRS) 2 or less. According to the TOAST (Trial of Org 10172 in Acute StrokeTreatment) and OCSP (Oxfordshire Community Stroke Project) study, ischemic stroke subtyping was performed. Serum NT-proBNP levels were estimated in 107 stroke patients and 24 age- and sex-matched control subjects. Venous blood samples were obtained for serum NT-proBNP measurement within the first 48 hours of the patient group. Mean age of the 107 AIS patients was 68 ± 15.22 years and 58.9% of them were women. Compared to controls, the SR, pAF and cAF groups had higher plasma NT-proBNP levels (P < 0.001) and also NT-proBNP values were significantly higher in the pAF and cAF group than SR groups (P < 0.001). NT-proBNP values were significantly higher in cardioembolic (CE) (n = 57) group than in large artery atherosclerosis (LAA) (n = 20) and small vessel disease (SVD) (n = 30) groups (P < 0.001). NT-proBNP levels of noncardioembolic SR (n = 49) (P = 0.080), LAA and SVD groups (P = 0.103) were higher than the control group but the difference was not statistically significant. There was a positive correlation between NT-proBNP level and third month mRS scores in CE group (r = 0.491). NT-proBNP will contribute to predict cardioembolic and pAF groups and estimate the prognosis.

Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure

Abstract Introduction The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95% CI: 0.76–0.97). Conclusion The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases. Funding Acknowledgement Type of funding sources: None. Figure 1

Preparation of Nanographene and Its Effect on the Correlation Between N-Terminal Pro Brain-Type Natriuretic Peptide, Peripheral Blood Copeptin Level and Cardiac Function Grading of Patients with Heart Failure

At present, biosensors based on nanomaterials are increasingly adopted in clinical detection of heart failure (HF) patients. This work aimed to analyze the correlation between N-terminal pro brain-type natriuretic peptide (NT-proBNP) and copeptin (CPT) levels in order to study the grading of heart function in patients with HF under the fluorescence platform built on nanographene. The and detection principle of of nanographene solution was prepared, and After its physical and chemical properties were tested, the nanographene solution was then used to detect the expression levels of NT-proBNP and CPT in patients with heart failure. Seventy-two patients with heart failure who came to hospital were selected as the observation group, and another 50 healthy people with physical examination were selected as the control group. The results showed that the constructed nanographene solution mixed with NT-proBNP didn’t exhibit fluorescence quenching. Therefore, it was feasible to detect NT-proBNP with nanographene solution. The test results obtained after the detection of different concentrations of nanographene showed that 20 μg/mL nanographene had the best fluorescence quenching effect. The ROC curve of the constructed nanographene had improved specificity in judging heart failure and had better diagnostic performance. The levels of pro-brain natriuretic peptide and copeptin in patients with heart failure were obviously higher than those in the observation group, and there was considerable difference between the two (P &lt; 0.05). After correlation analysis, it was found that the levels of terminal pro-brain natriuretic peptide and copeptin in patients with heart failure were positively correlated with the grade of heart function in patients with heart failure. In summary, the nanographene solution used in this study can accurately detect the expression level of NT-proBNP in patients with heart failure, and the accuracy and efficiency of diagnosis were improved in patients with heart failure. Moreover, the higher the grade of cardiac function in HF patients, the higher NT-proBNP and CPT levels, and there was positive correlation between cardiac function grade and NT-proBNP and CPT levels.

Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure

Introduction: The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods: A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results: A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95%CI:0.76-0.97). Conclusion: The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.

Characterisation of the patients with suspected heart failure: experience from the SHEAF registry

ObjectivesTo characterise and risk-stratify patients presenting to a heart failure (HF) clinic according to the National Institute for health and Care Excellence (NICE) algorithm.MethodsThis is an observational study of prospectively...

Preoperative levels of natriuretic peptides and the incidence of postoperative atrial fibrillation after noncardiac surgery: a prospective cohort study

Postoperative atrial fibrillation (POAF) is associated with clinically significant short- and long-term complications after noncardiac surgery. Our aim was to describe the incidence of clinically important POAF after noncardiac surgery and establish the prognostic value of N-terminal pro-brain-type natriuretic peptide (NT-proBNP) in this context. The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Study was a prospective cohort study involving patients aged 45 years and older who had inpatient noncardiac surgery that was performed between August 2007 and November 2013. We determined 30-day incidence of clinically important POAF (i.e., resulting in angina, congestive heart failure, symptomatic hypotension or requiring treatment) using logistic regression models to analyze the association between preoperative NT-proBNP and POAF. In 37 664 patients with no history of atrial fibrillation, we found that the incidence of POAF was 1.0% (95% confidence interval [CI] 0.9%-1.1%; 369 events); 3.2% (95% CI 2.3%-4.4%) in patients undergoing major thoracic surgery, 1.3% (95% CI 1.2%-1.5%) in patients undergoing major nonthoracic surgery and 0.2% (95% CI 0.1%-0.3%) in patients undergoing low-risk surgery. In a subgroup of 9789 patients with preoperative NT-proBNP measurements, the biomarker improved the prediction of POAF risk over conventional prognostic factors (likelihood ratio test p < 0.001; fraction of new information from NT-proBNP was 16%). Compared with a reference NT-proBNP measurement set at 100 ng/L, adjusted odds ratios for the occurrence of POAF were 1.31 (95% CI 1.15-1.49) at 200 ng/L, 2.07 (95% CI 1.27-3.36) at 1500 ng/L and 2.39 (95% CI 1.26-4.51) at 3000 ng/L. We determined that the incidence of clinically important POAF after noncardiac surgery was 1.0%. We also found that preoperative NT-proBNP levels were associated with POAF independent of established prognostic factors. Trial registration: ClinicalTrials.gov, no. NCT00512109.

Impact of NT-proBNP on Clinical Outcomes in Children with Systemic Inflammatory Response Syndrome

Objective: To evaluate the impact of elevated N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels on clinical outcomes in children that met criteria for systemic inflammatory response syndrome (SIRS). Background: NT-proBNP has traditionally been used in adults and children to diagnose and guide the treatment of congestive heart failure. Elevated NT-proBNP levels have been associated with increased morbidity and mortality in adults with septic shock. The association …

Association of NT-proBNP with clinical outcomes in children with systemic inflammatory response syndrome

N-terminal pro-brain type natriuretic peptide (NT-proBNP) has been reported to have an association with increased morbidity and mortality in adults with septic shock. The relationship between NT-proBNP levels and morbidity/mortality in children with systemic inflammatory response syndrome (SIRS) has not been studied. This was a retrospective study. The inclusion criteria were children (<18 years of age) who met the SIRS criteria and had NT-proBNP obtained between 2011 and 2017. Patients with final primary diagnoses related to cardiac disease were excluded. Patients were divided into 2 groups based on the value of NT-proBNP levels. Our cohort consisted of 44 patients after screening 4004 patients. Primary diagnoses were bacterial infection (n = 35, 80%), viral infection (n = 6, 14%), and Kawasaki disease (n = 3, 7%). Between elevated (n = 26) and non-elevated (n = 18) groups, there was no difference in age groups, gender, race, or final diagnoses. There were 5 deaths (11%). Children in the elevated group were more likely to require intensive care unit admission (odds ratio 20.0), mechanical ventilation (5.0), and inotropic support (9.4). Using receiver operator characteristic curve, the optimal cut-off values of NT-proBNP were 3034 pg/mL for inotropic support and mechanical ventilator use, 818 pg/mL for ICU admission, and 29,988 pg/mL for mortality. NT-proBNP levels were associated with increased morbidity in children with SIRS.

Anthracycline-induced cardiotoxicity in diffuse large B-cell lymphoma: NT-proBNP and cardiovascular score for risk stratification.

To evaluate the role of N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and a cardiovascular (CV) risk score named FRESCO for predicting anthracycline-induced cardiotoxicity (AIC) in diffuse large B-cell lymphoma (DLBCL). A total of 130 consecutive DLBCL patients treated in first-line with anthracycline-containing immunochemotherapy. Competitive risk between NT-proBNP, FRESCO, and time to AIC was considered. Cumulative incidence of AIC was 12.2% and 17.5% at 1 and 5years, respectively. Median time to development cardiotoxicity was 6.4months, with half of the cases showing heart failure and the other half silent AIC. Both NT-proBNP levels and FRESCO score were independently associated with higher risk of AIC (P=0.001 and P=0.03, respectively). Patients with NT-proBNP ≥600pg/mL or those with FRESCO ≥4.5% had 3.97 or 2.54 times higher risk of AIC than those with lower values (P=0.001 and P=0.048, respectively). According to the previous cutoffs, three groups of patients with a significantly different risk of AIC could be identified (P<0.0001). Doxorubicin-containing chemotherapy is associated with increased risk of silent and overt AIC. Baseline NT-proBNP levels and FRESCO CV risk score are accurate predictors of AIC and can identify groups of patients at different risk, in which personalized cardiologic evaluation should be offered.

Obstructive sleep apnea is associated with pulmonary artery thrombus load, disease severity, and survival in acute pulmonary embolism.

Obstructive sleep apnea (OSA) may have prothrombotic effects. To investigate the effect of OSA on disease severity, pulmonary artery thrombus load, and prognosis in patients with acute pulmonary embolism (PE). In 101 PE patients, disease severity was determined by the simplified PE severity index (sPESI) score, pulmonary artery thrombus load was quantified by the pulmonary artery obstruction index (PAOI), and sleep-disordered breathing was evaluated by nocturnal polygraphy. Obstructive sleep apnea patients with an apnea-hypopnea index (AHI) ≥ 15/h cohort were significantly older (p < 0.001) and had significantly lower oxygen saturations (p = 0.008) when acute PE was diagnosed. The sPESI scores (p < 0.001), the PAOI (p = 0.005) and the N-terminal pro-brain-type natriuretic peptide (NT-proBNP) values (p = 0.009), were significantly higher in the AHI ≥ 15/h subgroup. In a multivariate regression analysis, the AHI remains a significant predictor for sPESI scores ≥ 1 (p = 0.003), increased NT-proBNP levels (p = 0.047), and elevated PAOI (p = 0.032). During the median follow-up time of 53 (interquartile range 38-70) months, all-cause and cardiovascular-related mortality was significantly higher in the AHI ≥ 15/h cohort (p = 0.004 and p = 0.015, respectively). Obstructive sleep apnea is associated with pulmonary artery thrombus load, disease severity, and survival in acute PE possibly due to its prothrombotic effects.

N-Terminal Pro-Brain Natriuretic Peptide Predicts Long-Term Technique Failure in Patients Undergoing Peritoneal Dialysis.

It is unclear whether N-terminal pro-brain type natriuretic peptide (NT-proBNP) level can be a biomarker for technique failure among long-term peritoneal dialysis (PD) patients. We prospectively included end-stage renal disease patients undergoing PD from a single center between December 2011 and December 2017. We divided the cohort into high or low NT-proBNP groups and analyzed the risk factors associated with the incidence of technique failure using Cox proportional hazard regression analysis. A total of 258 chronic PD patients (serum NT-proBNP, 582 ± 1216 ng/mL) were included. After a mean follow-up of 3.6 years, 49.6% of PD patients developed technique failure and switched to hemodialysis, while 15.5% died. Cox proportional hazard regression analyses accounting for age, gender, diabetes, renal clearance, C-reactive protein, and hydration status, showed that higher natural log transformed NT-proBNP levels (hazard ratio [HR] 1.13, p < 0.01) were predictive of an increased risk of technique failure, and were also predictive of an increased risk of mortality (HR 1.56, p < 0.01). Consequently, NT-proBNP might be an under-recognized biomarker for estimating the risk of technique failure, and regular monitoring NT-proBNP levels among PD patients may assist in their care.

Total plasma sulfide in mild to moderate diastolic heart dysfunction

mechanisms of diastolic dysfunction are not understood well. Hydrogen sulfide is an important endogenous gaseous trans-mitter that can influence heart remodeling. The aim was to determine total plasma sulfide (TPS) levels, as a surrogate marker of hydrogen sulfide, in patients with mild diastolic dysfunction.Methods. Total plasma sulfide and N-ter-minal pro brain-type natriuretic peptide (NT-proBNP) levels were determined in ambulatory patients with arterial hyper-tension or diabetes mellitus and echocar-diographically mild to moderate diastolic dysfunction.Results. Twenty-four patients were in-cluded: nine with normal diastolic func-tion (Grade 0), eight with an impaired relaxation pattern (Grade 1), and seven with a pseudo-normalized pattern (Grade 2). TPS levels were highest in patients with normal diastolic function (Grade 0), and lowest in patients with Grade 2 diastolic dysfunction, with this difference between Grade 0 and Grade 2 showing statistical significance (p = 0.017). NT-proBNP lev-els showed the reverse behavior, with this difference again showing statistical signifi-cance (p = 0.042).Conclusions. Total plasma sulfide levels decrease with worsening of diastolic func-tion from normal to moderate diastolic dysfunction.&nbsp

NT-proBNP: When is it useful in Obstetric Medicine?

Pregnancy, viewed as a stress test of the haemodynamic system, may unmask underlying cardiac disease. Pregnancy may also induce de novo cardiac disease. N-terminal pro brain-type natriuretic peptide (NT-proBNP) is a useful biomarker in all clinical conditions in which the ventricle is stressed and especially stretched in the general population. In hypertensive diseases of pregnancy, increased levels of NT-proBNP in preeclampsia are associated with increased cardiac filling pressures and diastolic dysfunction. Increased levels of NT-proBNP in pregnant women with known cardiac disease may lead to earlier diagnosis of impending heart failure. Similarly, elevated levels of NT-proBNP assist with the diagnosis of peripartum cardiomyopathy and are increasingly used in follow-up. Women with known congenital heart disease who are pregnant can be screened for risk of cardiac events such as heart failure by the use of NT-proBNP levels. There is a paucity of data in pregnancy with the use of NT-proBNP and more research is needed.

Diagnostic significance of serum galectin-3 levels in heart failure with preserved ejection fraction.

Galectin-3, reflecting cardiac fibrosis, is a promising biomarker in early detection of heart failure with preserved ejection fraction (HFpEF). We aimed to clarify the clinical utility of galectin-3 levels in the diagnosis of HFpEF and to compare galectin-3 with N-terminal pro-brain-type natriuretic peptide (NT-proBNP) levels. The study included 44 HFpEF patients (mean age 60 ± 6.78 years, 24 men) and 38 control subjects (mean age 57 ± 8.98 years, 20 men). Galectin-3 and NT-proBNP levels were assessed by the ELISA kits. The receiver operating characteristics (ROC) curve was used to examine the diagnostic performance of galectin-3 and NT-proBNP in HFpEF. Galectin-3 and NT-proBNP levels were significantly increased in patients with HFpEF compared to controls [5.35 ng/ml (0.86 – 14.90) vs 0.51 ng/ml (0.15 – 1.71) P < 0.0001, 617.75 ± 271.30 pg/ml vs 66.35 ± 54.01 pg/ml P < 0.0001, respectively]. Galectin-3 correlated with NT-proBNP, left atrial volume index, left ventricular mass index, and E/E’ (r = 0.90, P < 0.0001; r = 0.75, P = 0.0001; r = 0.86, P = 0.0001; r = 0.80, P = 0.0001; respectively). The area under the ROC curve was 0.98 for galectin-3 and 1.0 for NT-proBNP. Our results support that, in addition to NT-proBNP, galectin-3 is also a valuable biomarker for the diagnosis of patients with HFpEF.

Diagnostic significance of serum galectin-3 levels in heart failure with preserved ejection fraction

Objective Galectin-3, reflecting cardiac fibrosis, is a promising biomarker in early detection of heart failure with preserved ejection fraction (HFpEF). We aimed to clarify the clinical utility of galectin-3 levels in the diagnosis of HFpEF and to compare galectin-3 with N-terminal pro-brain-type natriuretic peptide (NT-proBNP) levels.Methods and results The study included 44 HFpEF patients (mean age 60 ± 6.78 years, 24 men) and 38 control subjects (mean age 57 ± 8.98 years, 20 men). Galectin-3 and NT-proBNP levels were assessed by the ELISA kits. The receiver operating characteristics (ROC) curve was used to examine the diagnostic performance of galectin-3 and NT-proBNP in HFpEF. Galectin-3 and NT-proBNP levels were significantly increased in patients with HFpEF compared to controls [5.35 ng/ml (0.86 – 14.90) vs 0.51 ng/ml (0.15 – 1.71) P< 0.0001, 617.75 ± 271.30 pg/ml vs 66.35 ± 54.01 pg/ml P< 0.0001, respectively]. Galectin-3 correlated with NT-proBNP, left atrial volume index, left ventricular mass index, and E/E’ (r = 0.90, P< 0.0001; r = 0.75, P= 0.0001; r = 0.86, P= 0.0001; r = 0.80, P= 0.0001; respectively). The area under the ROC curve was 0.98 for galectin-3 and 1.0 for NT-proBNP.Conclusions Our results support that, in addition to NT-proBNP, galectin-3 is also a valuable biomarker for the diagnosis of patients with HFpEF.

Thioredoxin reductase activity, serum IL6, HsCRP and NT-proBNP levels in patients on dialysis /Diyaliz hastalarinda tiyoredoksin reduktaz aktivitesi, serum IL6, HsCRP ve NT-proBNP seviyeleri

Aim: Cytokines have a direct stimulating effect on natriuretic peptide secretion. N-terminal probrain type natriuretic peptide (NT-proBNP) is a valuable biomarker for mortality in dialysis patients. The aim of this study was to compare thioredoxin reductase, NT-proBNP, IL6 levels and high sensitive C reactive protein (HsCRP) in peritoneal dialysis (PD), and hemodialysis (HD) patients and investigate relationship among these parameters. Material and Methods: In age and sex matched 30 HD patients, in 30 PD patients and 20 healthy controls, HsCRP, thioredoxin reductase, serum IL6, and NT-proBNP levels were measured. Results: HsCRP, IL6 and NT-proBNP levels in HD and PD patients were significantly higher than in controls (p0.05). Thioredoxin reductase was not different in 3 groups (p>0.05). Thioredoxin reductase was not correlated with any studiedparameters. HsCRP levels were positively correlated with BMI (r:0.275, p:0.034), IL6 (r:0.633, p:0.000), and NT-proBNP (r:0.277, p:0.032), and negatively correlated with serum albumin levels (r:-0.425, p:0.001). Serum IL6 levels were positively correlated with HsCRP (r:0. 633 p:0.000), BMI (r:0.775, p:0.034) and negatively correlated with albumin (r:-0.342, p:0.007). Serum NT-proBNP levels were negatively correlated with serum albumin (r:-0.385, p:0.002), and positively correlated with age (r:0.315, p:0.002), HsCRP (r:0.277, p:0.032), systolic (r:0.421, p:0.001) and mean blood pressure (r:0.311, p:0.015). In multiple regression analyses the predictors of HsCRP were IL6 (β:0.677, p:0.000), the predictor of serum IL6 was HsCRP (β:0.677, p:0.000). The predictors of serum NT-proBNP levels were serum albumin (β:-0.416, p:0.000) and mean blood pressure (β:0.414, p:0.000). Conclusion: NT-proBNP levels are not related with IL6 levels and thioredoxin reductase in patients on dialysis.

Sonographic chest B-lines anticipate elevated B-type natriuretic peptide level, irrespective of ejection fraction.

BackgroundEchocardiography and the N-terminal pro-brain-type natriuretic peptide (NT-proBNP) level are important tests for assessing left ventricular function in patients presenting to the emergency department with acute dyspnea. Chest ultrasound is becoming an important tool in diagnosing acute pulmonary edema.AimTo assess the diagnostic accuracy of chest ultrasound examination using echocardiography and a curvilinear probe for detecting B-lines in patients presenting with acute pulmonary edema compared with assessment using NT-proBNP.MethodsThis paper reports a prospective observational study of 61 consecutive patients presenting with symptoms and signs of pulmonary edema and B-profile detected by echocardiography with a 5 MHz curvilinear probe. The emergency department physicians ordered NT-proBNP levels, and critical care physicians trained in ultrasound examination performed echocardiography and chest ultrasounds. The findings of the chest ultrasound were reviewed by another senior physician.ResultsSixty-one participants were enrolled over a period of 6 months (49.2 % male, with a mean age 66.8). Forty-seven of the 61 patients had a B-profile. The median NT-proBNP level in the patients with B-profile was 6200, compared with the mean level in the patients with an A-profile of 180 (CI 0.33–0.82). The distributions in the two groups differed significantly (p = 0.034). Based on a threshold level of NT-proBNP in relation to age, the sensitivity and specificity (including the 95 % confidence interval) were determined; the sensitivity of finding B-profile on ultrasound was 92.0 %, and the specificity was 91.0 %. The positive predictive value of the B-profile was 97.0 %, and the negative predictive value was 71.0 %. The systolic function in the subjects with a B-profile was below 50 in 84.3 % of the subjects and normal in 15.7 % of the subjects. An A-profile was present in all of the subjects with systolic function >55 %. In the subjects with a B-profile, 94 % had a Framingham score of CHF >4; the subjects with all A-profile had scores <4, p < 0.0001. There was an NHANES score of >3 in 96 % of the subjects with a B-profile, and all of the subjects with an A-profile had scores <3 (p < 0.0001).ConclusionsDetecting the B-profile with an echocardiography probe (curvilinear 5 MHz) in lung ultrasound is highly sensitive and specific for elevated NT-proBNP helping in diagnosing pulmonary edema, although of resolution inferior to micro convex probes.