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

Effectiveness of periodontal intervention on the levels of N-terminal pro-brain natriuretic peptide in chronic periodontitis patients.

Background: N-terminal-pro-brain natriuretic peptide (NT-proBNP) is an inactive hormone that is seen during inflammation and is a known biomarker of cardiovascular disease (CVD). Evidence suggests that periodontitis has a bidirectional relationship with CVD and NT-proBNP has a potential role in periodontal disease. However, there is no evidence on the impact of nonsurgical periodontal therapy (NSPT) on the levels of NT-proBNP in gingival crevicular fluid (GCF) and serum in patients with chronic periodontitis. Hence, the aim of this study was to compare the levels of NT-proBNP in GCF and serum in patients with chronic generalized periodontitis. Materials and methods: GCF and serum samples were collected in 19 patients with chronic periodontitis before and after NSPT after 6 weeks and the cumulative or reduction in values of NT-proBNP in GCF and serum was assessed. NT-proBNP levels in GCF and serum were determined by enzyme-linked immunosorbent assay. Results: The concentrations of NT-proBNP were significantly reduced in GCF and serum after NSPT. Statistically significant difference of NT-proBNP concentration between pre- and postgroups in GCF was apparent (p < 0.0001), whereas statistically nonsignificant results in NT-proBNP serum levels when compared at baseline to postoperative state with mean of 61.77 (22.6 standard deviation [SD]) preoperatively and 72.67 (51.86 SD) postoperatively (p = 0.0007) was observed. Conclusion: Significant reduction of NT-proBNP concentrations in GCF and serum in patients with chronic periodontitis subjected to NSPT was observed. This may account for a significant relation between periodontal disease, bacteremia, and CVD.

Prediction of congestive state and prognosis in acute and chronic heart failure: the association between NT-proBNP and left atrial strain

Abstract Background In acute and chronic heart failure (HF), the relief of congestion is one of the pivotal elements to improve patient's quality of life and prognosis. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-known marker of cardiovascular congestion in HF, although with limited specificity. Peak atrial longitudinal strain (PALS) by speckle tracking echocardiography is emerging as an index of left ventricular (LV) filling pressure and prognosis in HF, however, its role as a marker of congestion should be further elucidated. Purpose the aim of our study was to determine the association between NT-proBNP and PALS and their prognostic implications in patients acute and chronic HF. Methods patients hospitalized for de-novo or recurrent acute HF and patients with chronic HF referred to our echo-labs for follow-up evaluation were included in this retrospective study. Patients with missing data, previous cardiac surgery, heart transplant and/or left ventricular assist device implantation, non-feasible speckle tracking analysis were excluded. Clinical characteristics, laboratory examinations, transthoracic echocardiography data were collected. Speckle tracking analysis was performed offline on the echocardiographic records. Follow up data were obtained via electronical records or phone-calls. The primary clinical endpoint was a combination of all-cause death and HF hospitalization. Results the overall study cohort included 388 patients, of which 172 with acute HF and 216 with chronic HF. Mean age was 65±12, 37% were female. The majority of patients had reduced LV systolic function (mean LV ejection fraction = 30±10%; mean LV global longitudinal strain = −8.3±3.9%). Patients with acute HF presented higher values of NT-proBNP than those with chronic HF (median [interquartile range] = 6039 [2989; 13535]pg/ml vs. 544[200; 1533] pg/ml) and lower global PALS (10.4 [6.3; 16.45] vs. 15.6 [10.6; 21]%). Global PALS showed a significant inverse correlation with NT-proBNP both in acute and chronic HF (Fig. 1; all p<0.001) and to be a significant predictor of NT-proBNP with linear regression analysis (R2=0.2; p<0.001). During a median follow-up of 1 year, 98 patients reached the combined endpoint (49 all-cause deaths, 16 cardiovascular deaths, 62 HF hospitalizations). With ROC curves, both NT-proBNP and global PALS showed to be good predictors of the combined endpoint (AUC=0.87 and 0.82 respectively, Fig. 2). Kaplan-Meier analysis showed a good risk stratification for the composite endpoint for ROC-derived cut-off of PALS ≤15% and NTproBNP ≥874.5%, and above all for their combination (Fig. 1B) Conclusions global PALS is associated with NT-proBNP in acute and chronic HF and may be used as additional index of congestion to optimize therapeutic management in these patients. The combination of global PALS and NT-proBNP could enhance the prognostic stratification of HF. Funding Acknowledgement Type of funding sources: None.

Repositioning and optimization of left ventricular lead position in nonresponders to cardiac resynchronization therapy is associated with improved ejection fraction, lower NT-proBNP values, and fewer heart failure symptoms.

Observational data suggest that an anterior or apical left ventricular (LV) position in cardiac resynchronization therapy (CRT) is associated with worse outcome and higher likelihood of "nonresponse." It is not known whether the benefits of optimizing LV lead position in a second procedure outweighs the procedural risks. To evaluate the clinical effects of LV lead repositioning. During the period 2015-2020, we identified all patients in whom the indication for the procedure was LV lead repositioning owing to "nonresponse" in combination with suboptimal LV lead position. All patients were followed with a structured visit 6 months post LV lead revision. Heart failure hospitalization and mortality data were gathered from the medical records and cross-checked with the population registry. A total of 25 patients were identified who fulfilled the inclusion criteria. All procedures were successful in establishing LV lead pacing in a lateral mid or basal location. Median follow-up was 2.5 years [1.1-3.7]. There were improvements in NYHA class (mean -0.5 ± 0.5 class, P < .001), LV ejection fraction (+5 [interquartile range 2-11] absolute %, P = .01), QRS duration (-36 [-44 to -8], P < .001) and N-terminal pro-brain natriuretic peptide (NT-proBNP) (-615 [-2837 to +121] ng/L, P = .03). Clinical outcome was similar to a reference population with CRT (P = ns). In nonresponders to CRT with either an anterior or inferior LV lead position, it was feasible to perform LV lead repositioning in all cases, with a low complication rate. Changing the LV lead position was associated with improved LV ejection fraction, larger QRS reduction, and larger NT-proBNP reduction.

Vericiguat and NT-proBNP in patients with heart failure with reduced ejection fraction: analyses from the VICTORIA trial.

Treatment response to vericiguat, based on baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) subgroups specified in the protocol, was evaluated in the heart failure (HF) VICTORIA trial population by post hoc analysis of combined lower three quartiles [Q1-Q3] vs. the upper quartile [Q4]. VICTORIA participants with available baseline NT-proBNP levels (n=4805; 95.1% of total) were included. Compared with patients in Q1-Q3 (NT-proBNP: Q1, ≤1556pg/mL; Q2, >1556-2816pg/mL; and Q3, >2816-5314pg/mL), patients in Q4 (NT-proBNP: >5314pg/mL) were older (69.2±12.0 vs. 66.6±12.1years), had lower mean ejection fraction (27.2±8.3% vs. 29.5±8.2%; P<0.0001), and were more likely to be in New York Heart Association (NYHA) Class III (51.8 vs. 35.6%) or IV (2.4 vs. 1.0%). Compared with Q1-Q3, patients in Q4 had higher mean Meta-Analysis Global Group in Chronic Heart Failure risk score (27.3±6.6 vs. 23.5±6.4; P<0.0001), had lower mean estimated glomerular filtration rate (eGFR; 51.5±25.5 vs. 65.0±26.8mL/min/1.73m2 ; P<0.0001) and haemoglobin (12.8±2.0 vs. 13.6±1.9g/dL; P<0.0001), and more had atrial fibrillation (48.7% vs. 43.1%; P=0.0007) and were randomized while hospitalized for HF (14.8 vs. 9.9%; P<0.0001). Target dose was achieved in 72.3 and 63.7% of patients in Q1-Q3 and Q4, respectively (P<0.0001). Primary outcome (composite of time to cardiovascular death or first HF hospitalization) rates were 24.5 and 31.7 per 100 patient-years for vericiguat and placebo in Q1-Q3 [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.69-0.88, P<0.001] and 73.6 and 63.6 in Q4 (HR 1.15; 95% CI 0.99-1.34, P=0.070). Serious adverse events were more frequent in NT-proBNP Q4 (total population) compared with Q1-Q3 (38.3 vs. 32.3%; P=0.0001), driven mainly by the placebo group. Adverse events leading to death were more frequent in Q4 than Q1-Q3 (5.8 vs. 2.4%; P<0.0001). Plasma NT-proBNP may help identify patients with worsening HF with reduced ejection fraction, in whom the beneficial effects of vericiguat may be highest. Patients with highest NT-proBNP values are probably too far advanced, suffering more co-morbidities, or still clinically unstable after decompensation to derive benefit from vericiguat.

The Relationships Between Chocolate Consumption and Endothelial Dysfunction in Patients with Heart Failure

Dietary recommendations, in addition to medications, have recently become important in the treatment of heart failure. Our study aimed to show the positive effects of both milk chocolate and dark chocolate on heart failure through endothelial functions. Twenty patients with heart failure and reduced ejection fraction were included in the study. In this randomized, crossover study, some of the patients consumed milk chocolate and some consumed dark chocolate. We recorded the patients' 6-minute walking tests, flow- mediated dilatation values, plasma catechin, epicatechin, and N-terminal pro-brain natri- uretic peptide values before and after chocolate consumption. After 2 weeks, their chocolate consumption was changed. The same parameters were measured again. A significant decrease was observed in N-terminal pro-brain natriuretic peptide values after consumption of both milk chocolate (356 ± 54.2 and 310 ± 72.1 pg/mL; P = .007) and dark chocolate (341 ± 57 and 301 ± 60.1 pg/mL;P=.028). Flow-mediated dilation values increased after dark chocolate consumption (8.9 ± 3% and 14 ± 4.5%; P = .019). Chocolate consumption acutely decreases N-terminal pro-brain natriuretic pep- tide values in heart failure. Dark chocolate consumption also seems to improve endothelial functions by increasing flow-mediated dilation values.

Mitral Regurgitation and Serum N-Terminal Pro-Brain Natriuretic Peptide Levels in Children: A Modification of Adult Criteria.

Mitral regurgitation can result from congenital heart disease, rheumatic valve disease, or other congenital malformations of the mitral valve. Faulty valves require surgical repair or replacement. However, echocardiographic and biochemical parameters that inform surgical decision-making for adults may not be appropriate for children. To investigate whether adult parameters can be used in children, we correlated echocardiographic parameters with serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in children with chronic mitral regurgitation. Our sample comprised 45 patients and 38 healthy children. M-mode measurements, left atrial and left ventricular volumes, and Doppler and tissue Doppler echocardiograms were collected. We graded mitral regurgitation according to European Association of Echocardiography recommendations and indexed effective regurgitant area, vena contracta, and regurgitant volume to body surface area. Patients were grouped by regurgitation severity (mild vs moderate or severe) and left ventricular end-systolic dimension (normal vs enlarged). The NT-proBNP level was higher in patients than in controls (P=0.003), higher in patients with moderate or severe regurgitation (P=0.02), and higher in patients with an enlarged left ventricle (P=0.003). Serum NT-proBNP levels correlated with effective regurgitant area (r=0.47; P=0.002), vena contracta width (r=0.46; P=0.003), regurgitant volume (r=0.32; P=0.04), left ventricular end-systolic diameter (r=0.58; P <0.001), and left atrial diameter (r=0.62; P <0.001). An NT-proBNP value of 66 pg/mL differentiated the mild regurgitation group from the moderate or severe regurgitation group. Our results correlating NT-proBNP and echocardiographic parameters indexed to body surface area indicate that these adult criteria can be used in children to grade mitral regurgitation and inform surgical decision-making.

INVESTIGATION OF THE USE OF SERUM BIOMARKERS FOR THE DETECTION OF CARDIAC DISEASE IN MARINE MAMMALS.

Cardiac disease has been extensively documented in marine mammals; however, it remains difficult to diagnose antemortem. Assays measuring cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are used as sensitive and specific biomarkers of cardiac disease in many species, but have not been widely investigated in marine mammals. This study aimed to provide a set of reference values for cTnI and NT-proBNP in belugas (BW) (Delphinapterus leucas), sea otters (SO) (Enhydra lutris), Steller sea lions (SSL) (Eumetopias jubatus), and California sea lions (CSL) (Zalophus californianus) with and without cardiac disease, and to determine if these biomarkers are useful indicators of cardiac disease in these species. First, existing immunoassays for cTnI and NT-proBNP were successfully validated utilizing species-specific heart lysate spiked serum. Cohorts were defined by histopathology as animals with no evidence of cardiac disease ("control"), with confirmed cardiac disease ("disease"), and with concurrent renal and cardiac disease ("renal") for which serum samples were then analyzed. Serum concentration ranges for cTnI (ng/ml) and NT-proBNP (pmol/L) were determined for control and disease cohorts. There was significantly higher cTnI (P= 0.003) and NT-proBNP (P= 0.004) concentrations in the CSL disease cohort, as well as positive trends in BW, SO, and SSL disease cohorts that did not reach statistical significance. NT-proBNP concentrations were significantly higher in the CSL renal cohort compared with the control (P < 0.001) and disease (P= 0.007) cohorts. These results suggest that cTnI and NT-proBNP may be clinically useful in the antemortem diagnosis of cardiac disease in CSL, and warrant further investigation in BW, SO, and SL.

NT-proBNP Cut-off Values for Risk Stratification in Acute MI and Comparison with Other Risk Assessment Scores

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) provides prognostic information regarding the risk of death, acute heart failure and the development of AF in patients with acute coronary syndrome. While there are established cut-off values for the association between clinical risk assessment scores and in-hospital mortality, there is no clear cut-off value for NT-proBNP to guide risk stratification in patients with acute MI (AMI). Our study sought to evaluate the cut-off values of NT-proBNP in all-cause mortality post AMI and to compare with other available risk assessment scores. Methods: We conducted a multi-centre, prospective, observational study involving 411 patients admitted for AMI. Plasma NT-proBNP was assessed within 24 hours of admission. Results: One-year all-cause mortality occurred in 31 (7.6%) of 411 patients. NT-proBNP ≥404 pg/ml had an area under the curve of 0.66 (95% CI [0.54–0.77]; p=0.004) to predict all-cause mortality at 1 year (sensitivity: 80.6%; specificity: 36.9%; positive predictive value: 9.47%; negative predictive value: 95.89%). Using the Youden index, an NT-proBNP level ≥1,995 pg/ml was an independent predictor of all-cause mortality at 1 year (adjusted HR 2.6; 95% CI [1.3–5.5]; p=0.010), regardless of cardiovascular disease risk factors or revascularisation status. There were no significant differences among the predictive values of NT-proBNP, Thrombolysis in MI risk score, Global Registry of Acute Coronary Events risk score and left ventricular ejection fraction in predicting all-cause mortality at 1 year (p&gt;0.05). Conclusion: NT-proBNP level ≥1,995 pg/ml measured within 24 hours of admission for AMI was associated with higher all-cause mortality at 1 year. Randomised controlled trials are needed to further validate the usefulness of NT-proBNP for risk stratification in patients with AMI.

The Association of N-Terminal Pro-Brain Natriuretic Peptide With Time to Clinical Worsening in Hispanic Patients With Pulmonary Arterial Hypertension.

BackgroundMeasurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) level is an important parameter in the risk assessment of patients with pulmonary arterial hypertension (PAH). Data about the prognostic value of NT-proBNP in the Hispanic PAH population are lacking. Historically, clinical trials in PAH have only included a minority of Hispanic patients. It has been reported that baseline NT-proBNP levels differ between different ethnicities. Furthermore, NT-proBNP levels can be impacted by declining renal function, making its interpretation difficult regarding clinical decision making.MethodsIn a retrospective single-center cohort analysis, Hispanic patients with PAH had a baseline outpatient NT-proBNP level drawn during a period of clinical stability and were followed for 1 year to monitor for time to clinical worsening (TTCW). The association of baseline NT-proBNP and TTCW was assessed in patients with normal and abnormal renal function.ResultsA total of 26 patients (22%) met the clinical endpoint of clinical worsening. Twenty-seven patients (24%) had chronic kidney disease (CKD). At baseline NT-proBNP levels showed a significant inverse correlation with 6-min walk test (6MWD, r = -0.382, P = 0.02), and a significant positive correlation with renal function (r = 0.273, P = 0.05). NT-proBNP levels did not correlate with age (r = 0.19, P = 0.11) or body mass index (BMI) (r = -0.292, P = 0.061). NT-proBNP levels of > 1,415 ng/L were significantly associated with shorter TTCW (P < 0.01) in all patients and in patients with CKD (P = 0.03). A stepwise increase in NT-proBNP levels by 100 ng/L was associated with a higher risk of meeting the clinical endpoint of TTCW in patients with normal renal function (hazard ratio (HR) = 1.8, P < 0.01) and CKD (HR = 1.5, P < 0.01).ConclusionsIn Hispanic patients with PAH, NT-proBNP is a valuable tool to predict 1-year TTCW, independent of renal function.

Right Heart Reverse Remodeling Correlates with NT-proBNP Outcomes Among Pulmonary Arterial Hypertension Patients on Combination Therapy

<h3>Purpose</h3> Combination therapy is the current standard for severe pulmonary arterial hypertension (PAH). Few studies have characterized reverse remodeling achievable with therapy, and in particular, how it correlates with prognostic trends in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. We evaluated the longitudinal impact of PAH combination therapy on echocardiographic right heart parameters and observed how reverse remodeling correlates with a prognostic indicator of treatment response. <h3>Methods</h3> Thirty-two adults (age, 32±9years) with newly diagnosed PAH were initiated on combination therapy and had transthoracic echocardiograms performed prior to, and at least 3 months after, starting therapy. Pre- and follow-up NT-proBNP values were collected and speckle-tracking strain analysis was applied to echocardiogram images. Paired samples t-test was used to evaluate the statistical difference between baseline and follow-up measurements. <h3>Results</h3> After a mean 2.7 years, there was a significant decrease in mean RV basal diameter from 4.6cm to 4.2cm (p=0.03) and mean right atrial area from 23.6cm² to 19.8cm² (p<0.01). RV fractional area change (RVFAC) increased from 21% to 31% (p<0.01) and mean RV free wall strain (RVFWS) improved from -11.4% to -15.8% (p<0.01). Prior to therapy, 63% of patients had elevated NT-proBNP levels (>900pg/mL). By follow-up, there was a greater improvement in RVFAC among patients who maintained or achieved a normal NT-proBNP level with therapy compared to those whose biomarker level increased or remained elevated (+0.10% vs +0.003%, p=0.03). RVFWS improved to a greater extent in the former group compared to the latter, though this did not reach statistical significance (-5.32% vs. -0.86%, p=0.07). Five out of the 6 patients who died during follow-up maintained elevated NT-proBNP levels despite therapy. Half were on aggressive regimens including intravenous prostacyclin therapy. <h3>Conclusion</h3> While combination PAH therapy was associated with improved RV structure and function parameters among our cohort; patients with persistently elevated or deteriorated NT-proBNP levels demonstrated less reverse remodeling and had increased mortality. These findings highlight a need for novel future therapies that target right heart-specific remodeling pathways in high-risk PAH patients.

The Prognostic Value of N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) in Major Burn Patients With Sepsis.

The aim is to examine the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with major burns and sepsis. We collected the data of major burn patients who were admitted to our department. We compared the age, sex, burn area, burn depth, length of hospitalization, and mortality rate between the sepsis group and non-sepsis group and compared NT-proBNP, procalcitonin (PCT), platelet count, Sequential Organ Failure Assessment (SOFA) score, and quick SOFA (qSOFA) score between the survivors and nonsurvivors in the sepsis group. Receiver operating characteristic (ROC) curves were used in sepsis patients to evaluate the prognostic value of NT-proBNP, PCT, SOFA score, qSOFA score, etc. Kaplan-Meier survival curves were used to compare the 90-day survival curves of patients. Logistic regression analysis was used to analyze the risk factors that affect the prognosis of sepsis patients. There were 90 major burn patients with sepsis and 114 major burn patients without sepsis. The mortality rate for the major burn sepsis group was significantly higher than that for the non-sepsis group. The NT-proBNP level in sepsis patients in the nonsurvivor group was 2900 pg/ml, which was significantly higher than that in patients in the survivor group. Survival analysis showed that the mean survival time for the NT-proBNP &gt;2000 pg/ml group was 15.08 days. Multivariate regression analysis indicated that NT-proBNP was an independent risk factor for mortality in burn patients with sepsis. NT-proBNP can be used as a prognostic marker in patients with major burns and sepsis.

Age-Dependent Reference Values for hs-Troponin T and NT-proBNP and Determining Factors in a Cohort of Healthy Children (The LIFE Child Study)

This study aimed to provide reliable pediatric reference values for N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive Troponin T (hsTnT) obtained from a population of well children and investigate for associations with sex, pubertal status, body mass index (BMI), and serum lipid levels. We analyzed hsTnT and NT-proBNP values obtained from 4826 samples provided by 2522 children aged 0.25–18 years participating in a prospective longitudinal population-based cohort study, “LIFE child” in Leipzig, Germany (Poulain et al., Eur J Epidemiol 32:145–158, 2017). NT-proBNP values decreased throughout childhood from values over 400 ng/L at 3 months to 138 ng/L in females and 65 ng/L in males by 18 years of age. Values dropped rapidly with advancing pubertal stage. We found a strong association between lower NT-proBNP values and higher BMI or elevated serum lipids, the latter effect being more pronounced in males. For hsTnT levels, approximately half of the measurements were below the detection limit. However, 76% of those aged 3 months and 21% of those aged 6 months had values exceeding the adult cut-off limit. Females had slightly higher levels in the first 2 years of life but this was reversed during puberty. In males, there was an upward trend from pubertal stage 2 onward. We identified a positive association between hsTnT and BMI but a negative association with low-density lipoprotein (LDL) cholesterol and triglyceride levels in boys but not in girls. Based on a large number of healthy children, we have established reliable reference values for NT-proBNP and hsTnT for use in everyday clinical practice. We have also identified important associations between certain metabolic and cardiac markers.Clinical Trial Registration ClinicalTrial.gov (NCT02550236).

Differential diagnosis between pulmonary artery sarcoma and central chronic pulmonary thromboembolism:a preliminary study on CT signs

Objective: To improve the diagnostic accuracy of pulmonary artery sarcoma, and to distinguish it from central chronic pulmonary thromboembolism using CT scans. Methods: In this retrospective study, two groups of pulmonary artery sarcoma (PAS group) and central chronic pulmonary thromboembolism (central CPTE group) confirmed by pathology at our hospital between August 2009 and July 2019 were enrolled, clinical features and pre-operative CT pulmonary artery manifestation were collected, and the key points of differential diagnosis were summarized. Results: The study was composed of 13 cases in the PAS group including 10 males (76.9%), with an average age of (45.4±15.5) years. There were 19 patients in the central CPTE group including 14 males (73.7%), with an average age of (38.6±14.1) years. There were no significant differences in gender and age between the two groups. Deep venous thrombosis in the lower extremities was significantly higher in the central CPTE group than in the PAS group (7/19 vs. 0/13, P=0.025), and the N-terminal pro-brain natriuretic peptide value was higher in the central CPTE group than in the PAS group [674.50(261.70-1 977.70) vs. 66.00(28.10-505.50),P=0.001]. In CT pulmonary angiography, the involvement of the main pulmonary artery, and the proximal lesion showing an acute angle to the pulmonary artery wall were more common in the PAS group [11(84.6%) vs. 5(26.3%), P=0.003; 11(84.6%) vs. 2(10.5%), P<0.001, respectively]. The swelling index of the main pulmonary and the left/right main pulmonary arteries in the PAS group were significantly higher, as well as the dilatation in the lobar and segmental pulmonary arteries [1.19±0.17 vs. 0.99±0.19,P=0.006, 10(76.9%) vs. 2(10.5%), P<0.001, respectively]. The right ventricular transverse diameter/left ventricular transverse diameter (RVd/LVd) and pulmonary artery diameter/ascending aortic diameter ratio (Pad/Aod) were significantly lower in PAS group than those in the central CPTE group (0.97±0.19 vs. 1.23±0.35,P=0.020; 0.98±0.25 vs. 1.15±0.20,P=0.039). Conclusions: In CT pulmonary angiography, filling defects involving the main pulmonary artery and showing expansive growth were highly suggestive of pulmonary artery sarcoma. The history of deep venous thrombosis of the lower extremities was helpful for the diagnosis of chronic pulmonary embolism.

Early changes in N-terminal pro-brain natriuretic peptide levels predict new-onset heart failure in patients with STEMI.

Previous studies suggested that N-terminal pro-brain natriuretic peptide (NT-proBNP) level is a powerful independent predictor of death or heart failure (HF) when measured at admission in patients with chest pain or acute coronary syndrome. Little is known about the role of NT-proBNP level measured during a hospitalization for ST segment elevation myocardial infarction (STEMI) in predicting clinical outcomes. We evaluated the optimal NT-proBNP timing (admission, 72 hours, or delta [Δ] NT-proBNP [72 hours minus admission]) to predict 1-year new-onset HF in STEMI patients. We measured NT-proBNP levels at admission and 72 hours in 72 patients with STEMI. HF events were adjudicated and defined as hospitalization for HF or need for new initiation of a loop diuretic at 1-year follow-up. Values are presented as medians and interquartile range or frequencies (%) as appropriate. Cox regression analysis was used to determine predictors of adverse events. A receiver-operative-curve was constructed to identify the discriminative value and optimal cut-off points for NT-proBNP. Patients (age 56 [49-64] years, males 59 [82%]) were followed for a median duration of 365 [180-365] days. HF events were recorded in 9 (12.5%) patients. NT-proBNP values at admission, 72 hours, and ΔNT-proBNP were 89 (26-268) pg/mL, 452 (223-1064) pg/mL, and 283 (68-686) pg/mL, respectively. NT-proBNP at 72 hours and ΔNT-proBNP, but not admission NT-proBNP predicted new-onset HF events at follow-up (P=0.03, P=0.002 and P=0.89, respectively). The optimal area under the curve of 0.771 (95%, CI [0.630-0.912], P= 0.009) and cut-off value of 830 pg/mL (sensitivity 79%; specificity 76%) were found for NT-proBNP at 72 hours. The Kaplan-Meier survival curves for NT-proBNP at 72 hours dichotomized above and below this cut-off value, confirmed NT-proBNP at 72 hours >830 pg/mL as predictive of HF events (log-rank statistic = 8.688, P=0.003). NT-proBNP level at 72 hours and ΔNT-proBNP (72 hours minus admission), but not at time of admission, predicted HF events in patients following STEMI.

Association of Annual N-Terminal Pro-Brain Natriuretic Peptide Measurements With Clinical Events in Patients With Asymptomatic Nonsevere Aortic Stenosis

Recent studies have questioned the presumed low-risk status of patients with asymptomatic nonsevere aortic stenosis (AS). Whether annual N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements are useful for risk assessment is unknown. To assess the association of annual NT-proBNP measurements with clinical outcomes in patients with nonsevere AS. Analysis of annual NT-proBNP concentrations in the multicenter, double-blind Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) randomized clinical trial was performed. SEAS was conducted from January 6, 2003, to April 1, 2008. Blood samples were analyzed in 2016, and data analysis was performed from February 10 to October 10, 2021. SEAS included 1873 patients with asymptomatic AS not requiring statin therapy with transaortic maximal flow velocity from 2.5 to 4.0 m/s and preserved ejection fraction. This substudy included 1644 patients (87.8%) with available blood samples at baseline and year 1. Increased age- and sex-adjusted NT-proBNP concentrations at year 1 and a 1.5-fold or greater relative NT-proBNP concentration change from baseline to year 1. Moderate AS was defined as baseline maximal flow velocity greater than or equal to 3.0 m/s. Aortic valve events (AVEs), which are a composite of aortic valve replacement, cardiovascular death, or incident heart failure due to AS progression, were noted. Landmark analyses from year 1 examined the association of NT-proBNP concentrations with outcomes. Among 1644 patients, 996 were men (60.6%); mean (SD) age was 67.5 (9.7) years. Adjusted NT-proBNP concentrations were within the reference range (normal) in 1228 of 1594 patients (77.0%) with NT-proBNP values available at baseline and in 1164 of 1644 patients (70.8%) at year 1. During the next 2 years of follow-up, the AVE rates per 100 patient-years for normal vs increased adjusted NT-proBNP levels at year 1 were 1.39 (95% CI, 0.86-2.23) vs 7.05 (95% CI, 4.60-10.81) for patients with mild AS (P < .01), and 10.38 (95% CI, 8.56-12.59) vs 26.20 (95% CI, 22.03-31.15) for those with moderate AS (P < .01). Corresponding all-cause mortality rates were 1.05 (95% CI, 0.61-1.81) vs 4.17 (95% CI, 2.42-7.19) for patients with mild AS (P < .01), and 1.60 (95% CI, 0.99-2.57) vs 4.78 (95% CI, 3.32-6.87) for those with moderate AS (P < .01). In multivariable Cox proportional hazards regression models, the combination of a 1-year increased adjusted NT-proBNP level and 1.5-fold or greater NT-proBNP level change from baseline was associated with the highest AVE rates in both patients with mild AS (hazard ratio, 8.12; 95% CI, 3.53-18.66; P < .001) and those with moderate AS (hazard ratio, 4.05; 95% CI, 2.84-5.77; P < .001). The findings of this study suggest that normal NT-proBNP concentrations at 1-year follow-up are associated with low AVE and all-cause mortality rates in patients with asymptomatic nonsevere AS. Conversely, an increased 1-year NT-proBNP level combined with a 50% or greater increase from baseline may be associated with high AVE rates. ClinicalTrials.gov Identifier: NCT00092677.

Prognostic Value of NT-proBNP in Patients With Successful PCI for ACS and Normal Left Ventricular Ejection Fraction

BackgroundPatients undergoing successful percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) with normal left ventricular ejection fraction (LVEF) are generally considered to have successful clinical outcomes; however, there are still significant differences in clinical outcomes among these patients. The aim of the study was to find a common indicator to predict the risk of major adverse cardiac and cerebrovascular events (MACCE) in this population. MethodsA total of 3986 patients with ACS were divided into 4 groups based on the quartile (Q) values of peak N-Terminal pro-brain natriuretic peptide (NT-proBNP) measured during hospitalization. The incidence of MACCE was compared among Q1-Q4 groups during follow up. Multivariate Cox regression analysis was performed to identify independent prognostic factors of MACCE. Receiver operating characteristic (ROC) curve was generated to compare the area under the curve (AUC) for MACCE by adding NT-proBNP to the Thrombolysis in Myocardial Infarction (TIMI) risk score. ResultsNT-proBNP was significantly positively correlated with peak values of cardiac troponin I (cTnI) (r = 0.418), high-sensitivity C-reactive protein (hs-CRP) (r = 0.397) and left ventricular end-diastolic diameter (LVEDD) (r = 0.075) (P < 0.001). The risks of composite MACCE (5.6%, 9.1%, 13.0%, 20.1%, P < 0.001), all-cause death (1.0%, 2.5%, 4.1%, 8.4%, P < 0.001) and non-fatal myocardial infarction (2.0%, 3.4%, 4.8%, 6.2%, P < 0.001) were significantly higher in the higher Q groups. In multivariate analysis, the Q4 group displayed an independent 2.2-fold increase for MACCE compared to Q1 (HR: 2.16; 95%CI: 1.57-2.99; P < 0.001). Compared with TIMI risk score alone, TIMI+NT-proBNP showed improved AUCs: cardiovascular death (P = 0.0008), and heart failure requiring hospitalization (P = 0.0017). ConclusionsIn patients with ACS with successful PCI and normal LVEF, elevated NT-proBNP was significantly associated with poor clinical outcomes. These results suggest that NT-proBNP is a useful biomarker for prognosis and risk stratification in this population.

Predictive potential of age-group cut-off values of N-terminal pro-brain natriuretic peptide in Kawasaki disease.

The relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and the clinical features of patients with Kawasaki disease (KD) has been the subject of research. Recent studies have revealed that serum NT-proBNP levels vary with age. We therefore aimed to determine the utility of age-stratified cut-off values for NT-proBNP in predicting coronary artery lesions (CALs) in patients with KD. We retrospectively assessed the electronic medical records of patients who were hospitalized for KD or incomplete KD between January 1, 2015, and August 31, 2019. The patients were divided into high and normal NT-proBNP groups using age-stratified cut-off based on serum NT-proBNP levels measured immediately before KD treatment initiation. The study comprised 242 cases, including 71 and 171 cases in high and normal NT-proBNP groups, respectively. Thirty-seven of them (15.3%) were resistant to treatment; 15 (6.2%) had CALs, with a higher incidence in the high NT-proBNP group than in the normal NT-proBNP group. On multivariate logistic regression analysis, high serum NT-proBNP levels were significantly correlated to CALs (OR, 9.76; 95% CI, 2.64-36.2). On logistic regression analysis to compare the predictive accuracy of the age-stratified and fixed cut-off for CALs, the age-stratified cut-off values showed a larger area under the receiver operating characteristic curve than fixed cut-off value. Based on age-stratified cut-off values for serum NT-proBNP, high NT-proBNP levels at the time of diagnosis were significantly associated with CALs in patients with KD. Higher predictive accuracy for CALs of the age-stratified cut-off values was also suggested.

N-terminal prohormone B-type natriuretic peptide variability acts as a predictor of poor prognosis in patients with cardiorenal syndrome type 2

ABSTRACT This study aims to explore the effect of N-terminal pro-brain natriuretic peptide (NT-proBNP) variability (mean absolute difference of the log2 NT-proBNP level measured in hospital) on the prognosis of patients with cardiorenal syndrome (CRS) type 2. Patients with CRS type 2 were retrospectively included. The varied NT-proBNP indications were analyzed. They were NT-proBNP I(pre-treatment), NT-proBNP II(post-treatment), NT-proBNP II/I, ΔNT-proBNP, log2 (NT-proBNP) variability and mean log2 (NT-proBNP). A logistic regression model and survival curves (Kaplan–Meier analysis) were built to identify independent predictors associated with poor prognosis. The primary outcomes were major adverse renal and cardiac events. The secondary outcome was all-cause mortality. From 2012 to 2016, 136 patients were included in this study with 69 (50.7%) had high log2 (NT-proBNP) variability level. The optimal cutoff level for each NT-proBNP indication that predicts poor prognosis was calculated, and the area under curves ranged from 0.668 to 0.891 with different indications. Kaplan–Meier analysis revealed that there was significantly correlated with prevalence of primary outcomes and NT-proBNP variability. The hazard ratios (HRs) ranged from 1.67 to 6.61 with different indications. The multivariate regression analyses also identified the risk of the primary outcomes were associated with elevated NT-proBNP values, except NT-proBNP I. The odds ratio (ORs) ranged from 1.83 to 6.61 with different indications. When analyzing the relationship between NT-proBNP variability and all-cause mortality, the results were the same. NT-proBNP variability might serve as an independent predictor for poor prognosis and all-cause mortality in patients with CRS type 2.

Assessment of the impact of different N terminal pro brain natriuretic peptide thresholds on echocardiography services.

AimsN terminal pro brain natriuretic peptide (NT‐proBNP) is considered a rule‐out test for patients with suspected heart failure. The NT‐proBNP thresholds recommended for echocardiography by the European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) are based on small studies of patients with heart failure and left ventricular (LV) systolic dysfunction (LVSD). The purpose of our study was to examine the relation between NT‐proBNP and LVSD in a larger number of patients with symptoms suggestive of heart failure in a non‐acute setting.Methods and resultsOne thousand patients with suspected chronic heart failure underwent echocardiography within 6 months of NT‐proBNP measurement. NT‐proBNP was the strongest predictor of any form of LVSD in univariate (OR 2.52, 95% CI 2.19–2.91, P value < 0.001) and multivariate (OR 2.73, 95% CI 2.32–3.21, P value < 0.001) analyses. Negative predictive value (NPV) of NT‐proBNP for impaired LV systolic function (ejection fraction 35–49%) was 98% at 125 pg/mL (the ESC threshold), 93% at 400 pg/mL (the NICE threshold), 91% at 1000 pg/mL and 90% at 2000 pg/mL. Corresponding values for severe LVSD (ejection fraction <35%) were 100%, 99%, 98% and 96%. The number of patients per 1000 with suspected chronic heart failure requiring echocardiography at each threshold was 851, 543, 324, and 182, respectively.ConclusionsN terminal pro brain natriuretic peptide thresholds recommended by ESC and NICE result in large numbers of patients with suspected chronic heart failure being referred for echocardiography. Raising the NT‐proBNP threshold would improve access to echocardiography with minimal negative impact on the clinical performance of this cardiac biomarker.

270 Prediction of congestive state and prognosis in acute and chronic heart failure: the association between NT-proBNP and left atrial strain

Abstract Aims In acute and chronic heart failure (HF), the relief of congestion is one of the pivotal elements to improve patient’s quality of life and prognosis. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-known marker of cardiovascular (CV) congestion in HF, although with limited specificity. Peak atrial longitudinal strain (PALS) by speckle tracking echocardiography is emerging as an index of left ventricular (LV) filling pressure and prognosis in HF, however, its role as a marker of congestion should be further elucidated. The aim of our study was to determine the association between NT-proBNP and PALS in patients acute and chronic HF. Methods and results Patients hospitalized for de-novo or recurrent acute HF and patients with chronic HF referred to our echo-labs for follow-up evaluation were included in this retrospective study. Patients with missing data, previous cardiac surgery, heart transplant and/or left ventricular assist device implantation, non-feasible speckle tracking analysis were excluded. Clinical characteristics, laboratory examinations, transthoracic echocardiography data were collected. Speckle tracking analysis was performed offline on the echocardiographic records. Follow up data were obtained via electronical records or phone-calls. The primary clinical endpoint was a combination of all-cause death and HF hospitalization. The overall study cohort included 388 patients (172 with chronic HF and 216 with chronic HF). Mean age was 65 ± 12, 37% were female. Most patients had reduced LV systolic function (mean LV ejection fraction = 30 ± 10%; mean LV global longitudinal strain = −8.3 ± 3.9%). Patients with acute HF presented higher values of NT-proBNP than those with chronic HF [median (interquartile range) = 6039 (2989–13 535) pg/ml vs. 544 (200–1533) pg/ml] and lower global PALS =10.4 (6.3–16.45)% vs. 15.6 (10.6–21)%. Global PALS showed a significant inverse correlation with NT-proBNP both in acute and chronic HF (all P &amp;lt; 0.001) and to be a significant predictor of NT-proBNP with linear regression analysis (R2 = 0.2; P &amp;lt; 0.001). During a median follow-up of 1 year, 98 patients reached the combined endpoint (49 all-cause deaths, 16 CV deaths, 62 HF hospitalizations). With ROC curves, both NT-proBNP and global PALS showed to be good predictors of the combined endpoint (AUC = 0.87and 0.82, respectively, Figure 1). Conclusions Global PALS is associated with NT-proBNP in acute and chronic HF and may be used as additional index of congestion to optimize therapeutic management in these patients. Both global PALS and NT-proBNP confirmed to be accurate prognostic markers in HF.