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

The prevalence of pleural effusion in patients with heart failure and preserved ejection fraction using chest ultrasonographic assessment

Abstract Funding Acknowledgements None. Background The incidence of pleural effusions (PEs) radiologically in acute decompensated heart failure was estimated by 50 %( 1).The prevalence of PEs using chest ultrasound in patients with heart failure with preserved ejection fraction (HFpEF) was not studied before. Aim Determine the prevalence and severity of PE using bedside chest ultrasound in patients with HFpEF. Method We prospectively evaluated 85 patients admitted to the coronary care unit with acute pulmonary edema. 27 patients had LVEF below 50% and they were excluded. We used bedside ultrasonography to document the presence of pleural effusions and estimate the amount using Goecke 2 formula. Results 58 patients were recruited with estimated LVEF above 50% and median age of 73 years (Table 1). Pleural effusion was detected by chest ultrasound in 54 patients (94%) with 91% being bilateral and of moderate amount. The mean value of E/A and E/E’ ratio was 1.92 and 19.9 respectively where mean deceleration time (DT) was 171 ms , however, these parameters were not related to severity of pleural effusion (P= 0.52, 0.98 and 0.7 respectively) ( Table 2). The N-terminal pro-brain-type natriuretic peptide (NT-proBNP) was significantly higher in patients with pleural effusion (P = 0.046). Conclusion PEs are present on chest ultrasound in 94% of patients with HFpEF and mainly bilateral. The degree of PEs were moderate and was not related to the LV indices of HFpEF.

Evaluation of the European Society of Cardiology Risk Assessment Score in Incident Systemic Sclerosis-Associated Pulmonary Arterial Hypertension.

Patients with pulmonary arterial hypertension (PAH) may be stratified as low, intermediate, or high risk of 1-year mortality. In 2022, the European Society of Cardiology (ESC) updated and simplified its risk stratification tool, based on three variables: World Health Organization functional class, serum N-terminal pro-brain type natriuretic peptide and six-minute walk distance, applied at follow-up visits, intended to guide therapy over time. We applied the 2022 ESC risk assessment tool at baseline and follow-up (within 2 years) to a multinational incident cohort of systemic sclerosis-associated PAH (SSc-PAH). Kaplan-Meier curves, Cox hazards regression, and accelerated failure time models were used to evaluate survival by risk score. At baseline (n = 260), the majority of SSc-PAH (72.2%) were graded as intermediate risk of death according to the 2022 tool. At follow-up, according to 2022 tool, half (55.5%) of the cohort were classified as low or intermediate-low risk. The 2022 risk model at follow-up was able to differentiate survival between risk strata. All three individual parameters (World Health Organization functional class, N-terminal pro-brain type natriuretic peptide, six-minute walk distance) were significantly associated with mortality at baseline and/or follow-up. The 2022 ESC risk assessment strategy applied at baseline and follow-up predicts survival in SSc-PAH. Treatment decisions for SSc-PAH should include risk assessments, aiming to achieve low-risk status according to the 2022 ESC guidelines.

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.

Effect of Volume Removal by Hemodialysis on Elevated N-Terminal Pro Brain-Type Natriuretic Peptide (NT-ProBNP) Level

Effect of Volume Removal by Hemodialysis on Elevated N-Terminal Pro Brain-Type Natriuretic Peptide (NT-ProBNP) Level

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.

#4139 EFFECTS OF EMPAGLIFLOZIN ON FLUID OVERLOAD IN CHRONIC KIDNEY DISEASE: AN EMPA-KIDNEY BIOIMPEDANCE SUBSTUDY

Abstract Background and Aims The EMPA-KIDNEY trial showed that, compared to placebo, empagliflozin 10 mg once daily reduced the risk of kidney disease progression or cardiovascular death in 6609 patients with chronic kidney disease at risk of progression. We aimed to assess effects of empagliflozin on bioimpedance-measured fluid overload and adiposity in a subset to better understand the mechanisms of cardiovascular benefits of sodium glucose co-transporter-2 inhibitors. Method This EMPA-KIDNEY substudy added Body Composition Monitor (BCM) measurements at randomization and the 2 and 18 month follow-up visits to the trial's main protocol-specified procedures. The primary outcome was Absolute Fluid Overload (a parameter reflecting overhydration, derived from extracellular and intracellular resistance). Pre-specified subgroup analyses of the primary outcome were by sex, diabetes status, estimated glomerular filtration rate (eGFR) and N-terminal pro-brain-type natriuretic peptide (NT-proBNP) at baseline. The key secondary analysis was a composite of death from heart failure, heart failure hospitalisation or development of new moderate (&amp;gt;7%, ≤15%) or severe (&amp;gt;15%) BCM-measured Relative Fluid Overload. Tertiary outcomes included weight, anthropometry, and other BCM-measurements of body water and adiposity. The primary outcome was analysed used mixed-model repeated measures (MMRM) methods. The key secondary outcome used time-to-first event methods. Results A total of 660 EMPA-KIDNEY participants were recruited into this substudy. Mean age was 64 years, 205 (31%) were female and 245 (37%) had diabetes. Mean (SD) eGFR was 36 (12) ml/min/1.73m2 and median (Q1-Q3) NTpro-BNP was 211 (93-581) ng/L. Mean (SD) Absolute Fluid Overload at baseline was 0.4 (1.6) L, 19% had moderate fluid overload and 5% fulfilled criteria for severe fluid overload at baseline. Compared to placebo, the mean study average absolute difference in Absolute Fluid Overload was -0.24L (95% CI -0.38, -0.11), with similar differences at 2 months and 18 months (Figure 1). This difference was similar in men and women, in people with and without diabetes, and across the spectrum of eGFR and NT-proBNP studied (Figure 2). The number of key secondary outcomes was low and there was no significant difference in the risk of this outcome between treatment groups (35/332 [10%] vs 38/328 [12%], hazard ratio 0.91 [95% CI 0.57, 1.45], p = 0.69). Conclusion In patients with chronic kidney disease, empagliflozin reduced bioimpedance-measured fluid overload irrespective of diabetes status or level of eGFR. This effect persisted for at least 18 months with no evidence of attenuation over time. Funding Boehringer Ingelheim, Eli Lilly and others; Clinicaltrials.gov:NCT03594110.

Functional capacity testing in patients with pulmonary hypertension (PH) using the one-minute sit-to-stand test (1-min STST).

The one-minute sit-to-stand-test (1-min STST) is a quick, space saving test to evaluate functional capacity. Exercise testing plays an important role in the long-term follow-up of pulmonary hypertension (PH) patients and is currently evaluated using the six-minute-walk-test (6MWT). The aim of the study was to assess the convergent validity of the 1-min STST in patients with PH and its association with markers of PH severity. We evaluated 106 PH patients with the 1-min-STST and 6MWT and measured cardiorespiratory parameters (heart rate, blood pressure, oxygen saturation) before and after test conduction. N-terminal pro brain-type natriuretic peptide (NT-proBNP), WHO functional class (WHO-FC) and mean pulmonary artery pressure (mPAP) were defined as markers of PH severity. Strong correlation was found between performances of 1-min STST and 6MWT (r = .711, p < .001), indicating convergent validity. Both tests were inversely associated with NT-proBNP (STST: r = -.405, p < .001; 6MWT: r = -.358, p < .001), WHO-FC (STST: r = -.591, p < .001; 6MWT: r = -.643, p < .001) and mPAP (STST: r = -.280, p < .001; 6MWT: r = -.250, p < .001). Significant changes in cardiorespiratory parameters were observed in both tests (all p < 0.001). Further the post-exercise cardiorespiratory parameters correlated strongly between the 1-min STST and 6MWT (all r ≥ .651, all p < .001). The 1-min STST demonstrated good convergent validity with the 6MWT and was associated with markers of PH severity. Furthermore, both exercise tests caused similar cardiorespiratory responses.

Abstract P416: Higher Quality Diet is Associated With Lower Serum Levels of NT-proBNP

Introduction: N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is widely used as a diagnostic biomarker for heart failure. Higher diet quality is associated with lower risk of cardiovascular disease. However, the association between diet and subclinical cardiovascular disease, as assessed by biomarker concentrations, is less well-studied. Hypothesis: We hypothesized that higher diet quality, assessed by the Healthy Eating Index-2015 (HEI-2015), would be associated with lower serum levels of NT-proBNP. Methods: We included 9,782 adults from the National Health and Nutrition Examination Survey (NHANES), 1999-2004. The HEI-2015 ranges from 0 to 100, with higher scores indicating better diet quality, and was categorized into sex-specific quintiles. Weighted multivariable linear regression models were used to estimate associations between the overall HEI-2015 score as well as its 13 components and log-transformed NT-proBNP. Results: Among 9,782 participants, mean age was 45 years, 48% were men, and 72% were non-Hispanic White adults. After adjusting for sociodemographic characteristics, lifestyle factors, and medical history, persons in the highest HEI-2015 quintile had a 10.0% lower NT-proBNP level compared to those in the lowest HEI-2015 quintile (95% CI: -17.7% to -2.6%). There was a dose-response relationship between HEI-2015 and NT-proBNP ( Figure ). For each 1-unit higher sodium and added sugars score, NT-proBNP was lower by 7.7% and 6.8% respectively (95% CI: -13.8 % to -2.2%, and 95% CI: -13.1% to -0.9% respectively). Conclusion: Higher diet quality, especially lower intakes of sodium and added sugars, was associated with lower serum levels of NT-proBNP.

Cardiovascular medication in patients with raised NT-proBNP, but no heart failure in the SHEAF registry

ObjectivesWe aim to assess the association of cardiovascular medications with outcomes of patients referred to the diagnostic heart failure (HF) clinic with symptoms or signs of possible HF, raised N-terminal...

Cardiac Biomarkers and Risk of Atherosclerotic Cardiovascular Disease in Patients with CKD.

Several cardiac biomarkers of cardiac stress, inflammation, and fibrosis (N-terminal pro brain-type natriuretic peptide [NT-proBNP], high-sensitivity troponin T [hsTnT], growth differentiation factor 15 [GDF-15], and soluble ST2 [sST2]) have been associated with atherosclerotic disease in the general population. We hypothesized that these cardiac biomarkers may also be associated with the atherosclerotic cardiovascular disease in patients with CKD. We analyzed levels of NT-proBNP, hsTnT, GDF-15, and sST2 in a cohort of 2732 participants with mild to moderate CKD from the Chronic Renal Insufficiency Cohort (CRIC) study. Outcomes included incident atherosclerotic disease, defined as the first instance of myocardial infarction, stroke, or peripheral vascular disease. We used Cox proportional hazard models to the test the association of each cardiac biomarker with risk of incident atherosclerotic disease, adjusting for multiple possible confounders. When modeled continuously (per SD increase in the log-transformed biomarker), NT-proBNP, hsTnT, GDF-15, and sST2 were significantly associated with incident atherosclerotic disease after adjustment for multiple potential confounders: (NT-proBNP HR, 1.51; 95% CI, 1.27 to 1.81; hsTnT HR, 1.61; 95% CI, 1.38 to 1.89; GDF-15 HR, 1.44; 95% CI, 1.19 to 1.73; and sST2 HR, 1.19; 95% CI, 1.04 to 1.36). NT-proBNP, hsTnT, GDF-15, and sST2 were significantly associated with incident atherosclerotic cardiovascular disease in patients with CKD. These associations may highlight important mechanisms for the development of atherosclerotic disease in CKD.

Heart Failure Risk Predictions and Prognostic Factors in Adults With Congenital Heart Diseases.

In recent decades the number of adults with congenital heart diseases (ACHD) has increased significantly. This entails the need for scrupulous evaluation of the current condition of these patients. The ACHD population is one of the most challenging in contemporary medicine, especially as well-known scales such as the NYHA classification have very limited application. At the moment, there is a lack of universal parameters or scales on the basis of which we can easily capture the moment of deterioration of our ACHD patients' condition. Hence it is crucial to identify factors that are widely available, cheap and easy to use. There are studies showing more and more potential prognostic factors that may be of use in clinical practice: thorough assessment with echocardiography and magnetic resonance imaging (e.g., anatomy, ventricular function, longitudinal strain, shunt lesions, valvular defects, pericardial effusion, and pulmonary hypertension), cardiopulmonary exercise testing (e.g., peak oxygen uptake, ventilatory efficiency, chronotropic incompetence, and saturation) and biomarkers (e.g., N-terminal pro-brain type natriuretic peptide, growth-differentiation factor 15, high-sensitivity troponin T, red cell distribution width, galectin-3, angiopoietin-2, asymmetrical dimethylarginine, and high-sensitivity C-reactive protein). Some of them are very promising, but more research is needed to create a specific panel on the basis of which we will be able to assess patients with specific congenital heart diseases.

Elevated cardiac biomarkers and outcomes in children and adolescents with acute COVID-19.

Cardiac involvement associated with multi-system inflammatory syndrome in children has been extensively reported, but the prevalence of cardiac involvement in children with SARS-CoV-2 infection in the absence of inflammatory syndrome has not been well described. In this retrospective, single centre, cohort study, we describe the cardiac involvement found in this population and report on outcomes of patients with and without elevated cardiac biomarkers. Those with multi-system inflammatory syndrome in children, cardiomyopathy, or complex CHD were excluded. Inclusion criteriaz were met by 80 patients during the initial peak of the pandemic at our institution. High-sensitivity troponin T and/or N-terminal pro-brain type natriuretic peptide were measured in 27/80 (34%) patients and abnormalities were present in 5/27 (19%), all of whom had underlying comorbidities. Advanced respiratory support was required in all patients with elevated cardiac biomarkers. Electrocardiographic abnormalities were identified in 14/38 (37%) studies. Echocardiograms were performed on 7/80 patients, and none demonstrated left ventricular dysfunction. Larger studies to determine the true extent of cardiac involvement in children with COVID-19 would be useful to guide recommendations for standard workup and management.

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.

High-sensitivity cardiac troponin T determines all-cause mortality in cancer patients: a single-centre cohort study.

AimsCardio‐oncology is a growing interdisciplinary field which aims to improve cardiological care for cancer patients in order to reduce morbidity and mortality. The impact of cardiac biomarkers, echocardiographic parameters, and cardiological assessment regarding risk stratification is still unclear. We aimed to identify potential parameters that allow an early risk stratification of cancer patients.Methods and resultsIn this cohort study, we evaluated 930 patients that were admitted to the cardio‐oncology outpatient clinic of the University Hospital Heidelberg from January 2016 to January 2019. We performed echocardiography, including Global Longitudinal Strain (GLS) analysis and measured cardiac biomarkers including N‐terminal pro brain‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity cardiac troponin T levels (hs‐cTnT). Most patients were suffering from breast cancer (n = 450, 48.4%), upper gastrointestinal carcinoma (n = 99, 10.6%) or multiple myeloma (n = 51, 5.5%). At the initial visit, we observed 86.7% of patients having a preserved left ventricular ejection fraction (LVEF >50%). At the second follow up, still 78.9% of patients showed a preserved LVEF. Echocardiographic parameters or elevation of NT‐proBNP did not significantly correlate with all‐cause mortality (ACM) (logistic regression LVEF <50%: P = 0.46, NT‐proBNP: P = 0.16) and failed to identify high‐risk patients. In contrast, hs‐cTnT above the median (≥7 ng/L) was an independent marker to determine ACM (multivariant logistic regression, OR: 2.21, P = 0.0038) among all included patients. In particular, hs‐cTnT levels before start of a chemotherapy were predictive for ACM.ConclusionsBased on our non‐selected cohort of cardio‐oncological patients, hs‐cTnT was able to identify patients with high mortality by using a low cutoff of 7 ng/L. We conclude that measurement of hs‐cTnT is an important tool to stratify the risk for mortality of cancer patients before starting chemotherapy.

Is N-terminal pro-brain type natriuretic peptide a useful marker in newborns with heart defects?

Heart diseases are currently a significant cause of morbidity and mortality in newborns. The existing diagnostic methods are often not sufficient or, in many cases, cannot be used. Great advances have been achieved in medical knowledge concerning biomarkers for the diagnosis of circulatory system disorders in adult patients. Among these biomarkers, N-terminal pro-brain type natriuretic peptide (NT-proBNP) plays a main role. However, in the existing literature, there is not enough data concerning the physiological features of this biomarker in newborns and its potential use in neonatal cardiac diagnostics. To evaluate the diagnostic usefulness of NT-proBNP measurements in correlation with other markers of circulatory failure and myocardial damage in newborns with heart defects. This study involved 126 newborns. Patients were divided into 2 main groups: group I included infants with congenital heart defects (CHD) and group II (control) included healthy neonates. Newborns with CHD were further divided into 2 subgroups: group Ia with simple shunts and group Ib with combined heart defects. Patients in group I were further divided according to the hemodynamic significance of CHD. The NT-proBNP level was evaluated using the CARDIAC proBNP immunologic test (Cobas h232; Roche Diagnostics, Basel, Switzerland). The NT-proBNP concentrations were significantly higher in newborns with CHD compared to healthy ones. Newborns with combined heart defects had higher levels of NT-proBNP than newborns with simple shunts. The NT-proBNP concentrations in newborns with CHD correlated with echocardiographic parameters of hemodynamic significance and with left ventricular ejection fraction (LVEF). Additionally, NT-proBNP correlated with clinical symptoms of heart failure (HF; Ross classification, Reithmann's score). Statistically significant differences in NT-proBNP level between newborns with heart defects and healthy controls were shown. In newborns with heart diseases, significant correlations were found between NT-proBNP level and the type of heart defect (simple shunt or combined defects), the hemodynamic significance of the defect, LVEF, and the clinical intensity of HF.

Effectiveness and safety of exercise training and rehabilitation in chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis.

Patients with chronic thromboembolic pulmonary hypertension (CTEPH) still have impaired exercise training and quality of life (QoL) despite pulmonary arterial hypertension (PAH)-targeted drugs. Exercise training is considered to improve exercise capacity and QoL in patients with pulmonary hypertension (PH), but this has not been fully studied in CTEPH patients. We conducted the meta-analysis and systematic review to evaluate the effectiveness and safety of exercise training in patients with CTEPH. The relevant literature was retrieved for the meta-analysis using the PubMed, EMBASE, and Cochrane Library databases published before December 2020. The primary outcome was a change in six-minute walk distance (6MWD). We also assessed the effect of exercise training on peak oxygen uptake per kilogram (peak VO2/kg), mean pulmonary artery pressure (mPAP) assessed by right heart catheterization (RHC), N-terminal pro-brain-type natriuretic peptide (NT-proBNP), and QoL. A total of 6 studies with 234 exercise training patients were included. In the pooled analysis, 6MWD significantly improved by 70.14 m (WMD: 58.33 to 81.95, I2=0) after 3-week exercise training. After 12 or 15-week exercise training, 6MWD and peak VO2/kg significantly improved (WMD: 106.22 m, 95% CI: 65.90 to 146.55, I2=87.4%, P<0.0001; 1.84 mL/min/kg, 95% CI: 0.72 to 2.96, P=0.001, respectively). Furthermore, the mPAP decreased by 12.17 mmHg after 12-week exercise training (95% CI: -14.53 to -9.82, P<0.001, I2=99%). The subscales of QoL such as physical function, general health perception, and mental health improved in varying degrees. NT-proBNP did not improve significantly in the pooled analysis. In addition, exercise training was well tolerated without major adverse events occurred during training, and the dropout rate was low. Exercise training may improve exercise capacity, mPAP, and QoL, and was well tolerated among patients with CTEPH. However, more large-scale multicenter studies are needed to confirm the effectiveness and safety of exercise training in patients with CTEPH.

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.