Natriuretic Peptide In Patients Research Articles

Intestinal digestion effects and nursing measures of early intervention with recombinant human brain natriuretic peptide in patients with acute myocardial infarction after PCI.

Intestinal digestion effects and nursing measures of early intervention with recombinant human brain natriuretic peptide in patients with acute myocardial infarction after PCI.

Efficacy and safety of riociguat in the treatment of chronic thromboembolic pulmonary arterial hypertension: A meta-analysis.

Background:Riociguat is a novel soluble guanylate cyclase stimulator, and has been widely used for the treatment of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (CTEPH). Some studies found that riociguat had better effects on CTEPH and proved to be safe, but the results were not utterly consistent. Therefore, the purpose of this study was to comprehensively evaluate the efficacy and safety of riociguat in the treatment of CTEPH.Methods:Randomized controlled trials on riociguat for the treatment of CTEPH were searched through such electronic databases as PubMed, Embase, Cochrane Library, Web of Science, China national knowledge internet, and Wanfang. The outcomes included exercise capacity, pulmonary hemodynamics, and side effects. The fixed-effects or random-effects models were used to analyze the pooled data, and heterogeneity was assessed by the I2 test.Results:Four studies involving 520 patients were included in this meta-analysis. Compared with the placebo group, riociguat significantly improved the hemodynamic indexes and increased 6-min walking distance (P < .0001, standardized mean difference (SMD) = −0.24, 95%CI −0.35 to −0.12; P < .00001, SMD = 0.52, 95%CI 0.33 to 0.71), and decreased the Borg dyspnea score (P = .002, SMD = −0.31, 95%CI −0.51 to −0.12). In addition, riociguat could also significantly reduce the living with pulmonary hypertension scores and increase the EQ-5D scores (P = .01, SMD=−0.23, 95%CI −0.42 to −0.05; P < .00001, SMD = 0.47, 95%CI 0.27 to 0.66), but there was no significant difference in the change level of N-terminal pro-hormone B-type natriuretic peptide in patients with riociguat (P = .20, SMD = −0.24, 95%CI −0.61 to −0.13). The common adverse events of riociguat were dyspepsia and peripheral edema, and no other serious adverse reactions were observed.Conclusions:We confirmed that riociguat had better therapeutic effects in improving the hemodynamic parameters and exercise capacity in patients with CTEPH without inducing serious adverse events. This will provide a reasonable medication regimen for the treatment of CTEPH.

Role of soluble ST2 in short-term prediction of acute heart failure in acute ST-elevation myocardial infarction

Aim. To investigate the relationship of soluble ST2 (sST2) to acute heart failure (AHF) and compare the predictive value of sST2 and brain natriuretic peptide in patients with ST-elevation myocardial infarction (STEMI).Material and methods. In 136 STEMI patients, the serum sST2 concentration was determined during the first 24 hours of hospitalization. We assessed levels of sST2, N-terminal pro-brain natriuretic peptide (NT-proBNP), incidence of Killip class II-IV AHF during hospitalization, myocardial necrosis biomarkers, parameters of complete blood count and biochemical blood tests, the incidence of cardiovascular diseases and risk factors. The predictive value of sST2 for AHF development was assessed using logistic regression. ROC analysis was performed. The areas under the ROC curve were compared for sST2 and NT-proBNP. The cut-off sST2 value was determined for predicting AHF.Results. The mean sST2 level was 43,4 (33,6-73,9) ng/ml. During the followup period, AHF was diagnosed in 54 people (39,7%). The prevalence of AHF in the 1st, 2nd and 3rd tertiles of sST2 was 15,6%, 33,3% and 69,7%, respectively. The NT-proBNP levels were 319 (128-1072) pg/ml, 430 (147-1140) pg/ml and 1317 (533-2386) pg/ml. The predictive value of 3rd sST2 tertile was retained adjusted for age, sex, NT-proBNP, troponin T, creatine phosphokinase-MB, high-sensitivity C-reactive protein, hemoglobin, blood glucose, left ventricular ejection fraction. The areas under the ROC curves for sST2 and NT-proBNP were comparable (0,828 and 0,733, respectively; p=0,056). The cut-off sST2 value was 64 ng/ml, above which the odds ratio of AHF was 11,1 (95% confidence interval, 4,7-26,1.Conclusion. An increase in blood sST2 is associated with an increase in AHF (Killip II-IV) prevalence in hospitalized patients with acute STEMI. Soluble ST2 has an independent predictive value for AHF in STEMI, comparable in strength and predictive model quality to NT-proBNP. The cut-off sST2 value for AHF (&gt;64 ng/ ml) was calculated, which provides an optimal balance of sensitivity, specificity and accuracy of the prognostic model. These data support the potential value of sST2 as a biomarker of AHF in STEMI.

NT-pro brain natriuretic peptide in patients with type 2 diabetes mellitus without overt heart failure: a hospital based cross sectional study

Background: Increased secretion of brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) occurs mainly with increased tension in the ventricular walls, decreased oxygen supply, acute myocardial infarction, chronic cardiac heart failure, and in hypertrophy of the heart. Objective was to find out the prevalence and profile of NT-pro BNP levels in patients with type 2 diabetes mellitus (DM) without overt heart failure.Methods: Hospital based cross sectional observational study was conducted in the Department of Medicine, Pt. JNM Medical College and associated Dr. BRAM Hospital Raipur, Chhattisgarh involving 106 patients of type 2 DM during the period of April 2019 to April 2020, after ethical approval from institutional ethical committee.Results: The levels of NT pro BNP was found to be elevated in 87.7% patients of DM type 2. Majority of them were from 51-60 years age group (35.5%). Elevated NT proBNP levels was seen in 23.58% of patients having grade I diastolic dysfunction, 3.7% patients with grade II diastolic dysfunction and 1.88% patients having grade III diastolic dysfunction on echocardiography out of the 106 patients. Regardless of presence of diastolic dysfunction on echo, 93 (87.73%) patients out of the total study group of 106 patients had elevated BNP suggesting cardiac dysfunction. In the present study, 30.19% patients with diabetes were found to have varying degrees of diastolic dysfunction on echocardiography.Conclusions: The prevalence of elevated NT pro BNP was 87.7%. Commonly observed age group with elevated NT pro BNP was 51-60 years. NT pro BNP was elevated in 88.7% of males and in 88.36% of females. Prevalence of elevated NT pro BNP was higher in grade 1 diastolic dysfunction with DM duration of more than 5 years (33.3%). Higher prevalence of elevated NT pro BNP was seen in grade I diastolic dysfunction (23.58%).

The Additive Prognostic Value of Serial Plasma Interleukin-6 Levels over Changes in Brain Natriuretic Peptide in Patients with Acute Heart Failure

BackgroundElevated plasma interleukin-6 (IL-6) concentrations are frequently observed in patients with acute heart failure (AHF). However, the predictive value of serial IL-6 measurements beyond brain natriuretic peptide (BNP) remains poorly characterized. Methods and ResultsThis was a retrospective analysis of the PROTECT cohort (2033 patients with AHF). Plasma IL-6 and BNP levels were determined on days 1, 2, 7 and 14 after admission for AHF in 1591 (78.3%), 1462 (71.9%), 1445 (71.1%) and 1451 (71.4%) patients, respectively. The primary endpoint was 180-day all-cause mortality. The median day-1 IL-6 concentration was 11.1 pg/mL (IQR: 6.6, 20.9) and decreased to 10.1 pg/mL (IQR: 5.6-18.5) at day-7. Higher cross-sectional IL-6 concentrations at all time-points predicted the primary endpoint, independent of a risk model for this cohort and changes in BNP. Each doubling of IL-6 between day-1 and day-7 predicted the primary endpoint independent of baseline IL-6 concentrations, the risk model, baseline BNP and changes in BNP [HR (95% CI): 1.18 (1.07-1.30), p=0.0013]. Collectively, 214 (17%) patients experienced at least a doubling of their IL-6 concentrations between day-1 and day-7. ConclusionsWe demonstrate that the temporal evolution patterns of IL-6 in patients with AHF have additive prognostic value independent of changes in BNP.

РАННИЕ И АЛЬТЕРНАТИВНЫЕ МАРКЕРЫ РАЗВИТИЯ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ У ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ

Aim: to assess the relationship of proinflammatory cytokines and chemokines with the levels of natriuretic peptides in patients with diabetes mellitus (DM). Materials and methods. A total of 155 patients (14 men and 61 women) with type 1 and type 2 diabetes, aged 34 to 84 years, were examined. All patients underwent standard clinical and laboratory examination, with an assessment of the levels of pro-inflammatory cytokines (interleukin 6 (IL-6), tumour necrosis factor alpha (TNF-alpha), chemokines (monokine induced by interferon-gamma (MIG), regulated upon activation, normal T cell expressed and presumably secreted (RANTES), growth factors (fibroblast growth factor-23 (FGF-23), vascular endothelial growth factor (VEGF-A), natriuretic peptides (B‐type natriuretic peptide (BNP), N‐terminal fragment of B‐type natriuretic peptide (proBNP). Renal function was assessed based on the levels of serum creatinine, glomerular filtration rate (GFR), which was calculated according to the CKD-EPI formula, and albuminuria, which was assessed as albumin/creatinine ratio (A/C). An echocardiographic examination was conducted according to the standard protocol with the calculation of dimensional, volume and speed characteristics. Statistical data analysis was performed using smSTATA 14.2 for Mac (2018). Results. 57% DM patients had BNP and proBNP levels exceeding the diagnostic values of BNP &gt;35 pg/ml and/or proBNP &gt;125 pg/ml. The levels of BNP and proBNP positively correlated with the levels of homocysteine, uric acid, IL-6, С-reactive protein (CRP), high-sensitivity C-reactive protein (hsCRP), A/С, creatinine, cystatin C, TNF-alpha, chemokines (MIG, RANTES), growth factors (FGF-23, VEGF-A) (p &lt;0.05). According to multiple regression analysis, predictors for increased proBNP were IL-6, A/K, creatinine (ß=0.70, p&lt;0.001, ß=3.51, p=0.01, ß=0.97, p=0.01, respectively). ROC analysis determined the highest diagnostic significance of creatinine for the prediction of increased proBNP. The significance of IL-6 proved higher than A/С (AUC-0.777). Thus, when the level of IL-6 (AUC-0.789) was 3.1 mg/ml, the sensitivity and specificity for increased proBNP concentration were 71.9% and 71.2%, respectively. Conclusion. IL-6 might be an independent predictor of increased levels of natriuretic peptide in patients with diabetes. Further study of the role of pro-inflammatory cytokines in the development of cardiovascular diseases will make it possible to finally decode the mechanisms of their pathogenesis, which will further allow us to understand their complex effect on the body and obtain information for the development of new effective and safe specific medicines.

Efficacy of exogenous atrial natriuretic peptide in patients with heart failure with preserved ejection fraction: deficiency of atrial natriuretic peptide and replacement therapy

AimsExogenous atrial natriuretic peptide (ANP) may be a logical treatment for heart failure (HF) patients with ANP deficiency. Lower ANP concentrations may result from HF with preserved ejection fraction (HFpEF), which also results in lower brain natriuretic peptide levels in HFpEF relative to HF with reduced ejection fraction (HFrEF), although clinical features regarding circulating ANP in HFpEF and HFrEF have not been fully investigated during acute HF. Here, we characterized the differential regulation of circulating ANP and the efficacy of exogenous ANP (carperitide) in patients with acute HF, especially HFpEF.Methods and resultsSerum ANP levels before treatment and the diuretic effect of 0.0125 μg/kg/min of carperitide alone for the first 6 h were prospectively evaluated in 113 patients with acute HF who were divided into two groups: HFpEF vs. HFrEF. We mainly analysed the impact of baseline ANP levels and the presence of HFpEF on the diuretic effect of exogenous ANP. There was an inverse relationship between ANP levels and the diuretic effect of exogenous ANP (r 2 = 0.19, P < 0.001). Patients with HFpEF had lower ANP levels (P < 0.001) and a greater diuretic effect of exogenous ANP than patients HFrEF (P < 0.001). HFpEF was an independent predictor of greater diuretic effect of exogenous ANP (P = 0.003), as with a lower baseline ANP level (P = 0.004).ConclusionsPatients with HFpEF might have an aspect of ANP deficiency and represent a promising therapeutic target for modulating circulating ANP.

Changes in the Left Ventricular Ejection Fraction and Natriuretic Peptides in Heart Failure Patients with Moderately Reduced and Preserved Ejection Fraction Treated Following Transvenous Stimulation of the Phrenic Nerve for Central Sleep Apnea

Introduction Central sleep apnea is a frequent finding in heart failure (HF) and is being increasingly reported in heart failure patients with preserved ejection fraction (HFpEF). Mechanisms of CSA occurrence in those with HFpEF may be similar to CSA in HF with reduced ejection fraction (HFrEF). While treatment of CSA in HFrEF has been reported to be safe and associated with improved sleep metrics, long-term follow-up in patients with moderately reduced ejection fraction (HFmrEF - EF 40-50%) or HFpEF (EF > 50%) and CSA is not well understood. The aim of this analysis was to evaluate changes in LVEF and natriuretic peptides in patients with HFmrEF or HFpEF and CSA following transvenous phrenic nerve stimulation (TPNS). Hypothesis We hypothesized no meaningful reduction in LVEF or increase in natriuretic peptides would be observed. Methods Patients who participated in the remedē system Pivotal trial had TPNS activated 1-month post-implant in the treatment group and 6-months post-implant in the control group. The groups were then pooled for post hoc analysis based on months of active therapy. Echocardiography was performed at 6, 12, and 18 months with attention to EF%, particularly in those without permanent atrial fibrillation, as well as measurement of BNP or NT-pro-BNP at those time points. Results : The HFmrEF group had a median EF of 49.5% [interquartile range (IQR) - 47.0, 53.0] (n=10) at 18 months with a paired change from baseline of 5.0% [2.0, 8.0] (p = 0.031). The HFpEF group had an EF of 56.0% [54.0, 58.0] (n = 10) at 18 months with a paired change from baseline of 1.5% [0.0, 4.0] (p = 0.086). Based on pooled data there was no clinically meaningful change in BNP or NT-pro-BNP over the course of 18 months of active therapy (Table 1). Conclusions This analysis shows no clinically meaningful change in EF based on echocardiographic changes and no clinically meaningful changes in natriuretic peptides following TPNS activation in patients with HFmrEF or HFpEF. Future studies in this patient population should be considered.

A comparison of intraoperative goal-directed intravenous administration of crystalloid versus colloid solutions on the postoperative maximum N-terminal pro brain natriuretic peptide in patients undergoing moderate- to high-risk noncardiac surgery

BackgroundN-terminal pro brain natriuretic peptide (NT-proBNP) and troponin T are released during myocardial wall stress and/or ischemia and are strong predictors for postoperative cardiovascular complications. However, the relative effects of goal-directed, intravenous administration of crystalloid compared to colloid solutions on NT-proBNP and troponin T, especially in relatively healthy patients undergoing moderate- to high-risk noncardiac surgery, remains unclear. Thus, we evaluated in this sub-study the effect of a goal-directed crystalloid versus a goal-directed colloid fluid regimen on postoperative maximum NT-proBNP concentration. We further evaluated the incidence of myocardial injury after noncardiac surgery (MINS) between both study groups.MethodsThirty patients were randomly assigned to receive additional intravenous fluid boluses of 6% hydroxyethyl starch 130/0.4 and 30 patients to receive lactated Ringer’s solution. Intraoperative fluid management was guided by oesophageal Doppler-according to a previously published algorithm. The primary outcome were differences in postoperative maximum NT-proBNP (maxNT-proBNP) between both groups. As our secondary outcome we evaluated the incidence of MINS between both study groups. We defined maxNT-proBNP as the maximum value measured within 2 h after surgery and on the first and second postoperative day.ResultsIn total 56 patients were analysed. There was no significant difference in postoperative maximum NT-proBNP between the colloid group (258.7 ng/L (IQR 199.4 to 782.1)) and the crystalloid group (440.3 ng/L (IQR 177.9 to 691.2)) during the first 2 postoperative days (P = 0.29). Five patients in the colloid group and 7 patients in the crystalloid group developed MINS (P = 0.75).ConclusionsBased on this relatively small study goal-directed colloid administration did not decrease postoperative maxNT-proBNP concentration as compared to goal-directed crystalloid administration.Trial registrationClinicalTrials.gov (NCT01195883) Registered on 6th September 2010.

Highest Obesity Category Associated With Largest Decrease in N-Terminal Pro-B-Type Natriuretic Peptide in Patients Hospitalized With Heart Failure With Preserved Ejection Fraction.

BackgroundHeart failure with preserved ejection fraction (HFpEF) constitutes half of hospitalized heart failure cases and is commonly associated with obesity. The role of natriuretic peptide levels in hospitalized obese patients with HFpEF, however, is not well defined. We sought to evaluate change in NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels by obesity category and related clinical outcomes in patients with HFpEF hospitalized for acute heart failure.Methods and ResultsA total of 89 patients with HFpEF hospitalized with acute decompensated heart failure were stratified into 3 obesity categories: nonobese (body mass index [BMI] <30.0 kg/m2, 19%), obese (BMI 30.0–39.9 kg/m2, 29%), and severely obese (BMI ≥40.0 kg/m2, 52%), and compared for percent change in NT‐proBNP during hospitalization and clinical outcomes. Clinical characteristics were compared between patients with normal NT‐proBNP (≤125 pg/mL) and elevated NT‐proBNP. Admission NT‐proBNP was inversely related to BMI category (nonobese, 2607 pg/mL [interquartile range, IQR: 2112–5703]; obese, 1725 pg/mL [IQR: 889–3900]; and severely obese, 770.5 pg/mL [IQR: 128–1268]; P<0.01). Severely obese patients had the largest percent change in NT‐proBNP with diuresis (−64.8% [95% CI, −85.4 to −38.9] versus obese −40.4% [95% CI, −74.3 to −12.0] versus nonobese −46.9% [95% CI, −57.8 to −37.4]; P=0.03). Nonobese and obese patients had significantly worse 1‐year survival compared with severely obese patients (63% versus 76% versus 95%, respectively; P<0.01). Patients with normal NT‐proBNP (13%) were younger, with higher BMI, less atrial fibrillation, and less structural heart disease than those with elevated NT‐proBNP.ConclusionsIn hospitalized patients with HFpEF, NT‐proBNP was inversely related to BMI with the largest decrease in NT‐proBNP seen in the highest obesity category. These findings have implications for the role of NT‐proBNP in the diagnosis and assessment of treatment response in obese patients with HFpEF.

Angiotensin Receptor Neprilysin Inhibitors-2019 Update.

An abundance of new data regarding the use of the novel drug compound sacubitril/valsartan in chronic heart failure (CHF) patients is published every year since the initial publication of the PARADIGM-HF study in 2014. This review summarises the most recent evidence (2019 and onwards) of sacubitril/valsartan in CHF patients as well as provides a critical appraisal of these data. New data are grouped in categories such as real-world data, randomised controlled trials, surrogate end-points, cost-effectiveness, use of sacubitril/valsartan as an anti-hypertensive treatment, effect on diuretic dosing and implementation of this novel compound in other populations. This review of recent literature identified important messages such as early initiation during index hospitalisation or immediately post-discharge, barriers against implementation of this novel treatment modality, analytical issues regarding measuring natriuretic peptides in patients under treatment and extrapolated use of sacubitril/valsartan in other than PARADIGM-HF populations. This update may serve as a very helpful evidence-based resource for practising clinicians, future research planning and health-related policy makers.

Cardiac Troponin I Predicts Elevated B-type Natriuretic Peptide in Patients Treated with Anthracycline-Containing Chemotherapy

Background: Anthracycline is used to treat various types of cancer; however, cardiotoxicity negatively affects patient prognosis. Objectives: The aim of the present study was to investigate serial changes in levels of cardiac troponin I (TnI) and B-type natriuretic peptide (BNP) in patients treated with anthracycline-containing therapy. Methods: 91 consecutive cancer patients planned for anthracycline treatment were enrolled and followed up for 12 months. All patients underwent echocardiography and blood sampling at baseline, 3, 6, and 12 months. Results: The patients were divided into two groups based on their TnI level during the follow-up period: the elevated TnI group (TnI ≥0.03 ng/mL; n = 37) and the normal TnI group (n = 54). In the elevated TnI group, the TnI levels increased at 3 and 6 months, but they returned to within normal range at 12 months after anthracycline administration. Unlike TnI, the BNP levels began to increase after 6 months, and remained increased at 12 months. The occurrence of cancer therapeutics-related cardiac dysfunction was higher in the elevated TnI group than in the normal TnI group. When we set the cut-off value of TnI at 0.029 ng/mL, sensitivity and specificity to predict an elevated BNP level of more than 100 pg/mL were 90 and 63%, respectively. Multivariate logistic regression analysis revealed that elevated TnI was an independent predictor of elevated BNP levels. Conclusion: Elevated TnI was an independent predictor for the development of BNP increase. The different characteristics of TnI and BNP should be considered when managing patients treated with anthracycline-containing therapy.

Relationships among pulmonary capillary wedge pressure, dry weight and natriuretic peptide in patients undergoing hemodialysis: a three-dimensional speckle tracking echocardiography study.

Although the evaluation of fluid status in hemodialysis (HD) patients is useful, relationship among pulmonary capillary wedge pressure (PCWP), dry body weight (DW) and natriuretic peptide has not been elucidated. In addition, there has been no objective marker for instantaneously monitoring hemodynamic improvement in response to HD. We previously reported that PCWP and time constant of left ventricular pressure decline (Tau) can be noninvasively estimated (ePCWP and eTau) by speckle tracking echocardiography (STE). The aim of this study was to elucidate the relationship among ePCWP, eTau, DW and natriuretic peptide in patients undergoing HD. We measured ePCWP and body weight (BW) by STE in 81 patients and ANP and BNP by blood examination in 31 patients just before and after HD during sinus rhythm. The ePCWP decreased after HD, and this was associated with reductions in ln ANP, eTau and BW (r = 0.523, 0.271 and 0.814, respectively, p < 0.05). The % change in ePCWP was not correlated with the % change in ln BNP (p = 0.47). The change in ePCWP had a stronger correlation with the % change in BW than the change in any other parameters. The ePCWP is more sensitive to estimate the change in BW during HD than any other parameters such as ANP and BNP. These results indicated that a substantial amount of excess fluid can be assessed real-time by STE using ePCWP.

Уровень N-терминального фрагмента прогормона мозгового натрийуретического пептида у пациентов с разным объемом замещения при on-line гемодиафильтрации

Уровень N-терминального фрагмента прогормона мозгового натрийуретического пептида у пациентов с разным объемом замещения при on-line гемодиафильтрации

The Impact of Body Mass Index on the Prognostic Value of N-Terminal proB-Type Natriuretic Peptide in Patients with Heart Failure: an Analysis from the Korean Heart Failure (KorHF) Registry.

Background and ObjectivesAlthough an inverse correlation between the level of amino (N)-terminal pro-brain natriuretic peptide (NT-proBNP) and body mass index (BMI) has been reported, the impact of BMI on the prognostic value of NT-proBNP has not been well addressed.MethodsA total of 1,877 patients (67-year-old and 49.9% females) hospitalized for acute heart failure (HF) with documented NT-proBNP levels at baseline were included. Patients were classified into 2 groups by BMI (nonobese: BMI<23 kg/m2 and overweight or obese: BMI≥23 kg/m2). Clinical events during the follow-up including all-cause mortality and HF readmission were assessed.ResultsDuring the median follow-up of 828 days (interquartile range, 111–1,514 days), there were 595 cases of total mortality (31.7%), 600 cases of HF readmission (32.0%), and 934 cases of composite events (49.8%). In unadjusted analyses, higher NT-proBNP level was associated with all-cause mortality and composite events (all-cause mortality and HF readmission) in both patients with BMI<23 kg/m2 and those with BMI≥23 kg/m2. In adjusted analyses controlling for potential confounders, however, a higher NT-proBNP level was associated with all-cause mortality and composite events in patients with BMI<23 kg/m2, but not in those with BMI≥23 kg/m2.ConclusionsThe prognostic value of NT-proBNP was more significant in nonobese patients than in overweight and obese patients in this HF population. BMI should be considered when NT-proBNP is used for risk estimation in HF patients.

Impairment in heart functions and prognostic role of N-terminal pro-brain natriuretic peptide in patients with chronic obstructive pulmonary disease exacerbation

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) with comorbidities and cardiovascular disease is the most frequent one. The role of natriuretic peptides in determining prognosis of COPD exacerbations is not yet clear. The frequency of pathologic findings of transthoracic echocardiography (TTE) during COPD exacerbation showed wide variability. This study aims to evaluate the predictive role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in determining the short-term prognosis of patients hospitalized with COPD exacerbation. As a secondary outcome, we aimed to investigate the frequency of TTE findings in these patients. MATERIALS AND METHODS: Eighty-six consecutive patients with COPD exacerbation were included. NT-proBNP levels were measured and TTE was carried out to whole of the participants at administration. The primary outcome was development of “event” (readmission or rehospitalization or mortality) within 30 days. The predictive role of NT-proBNP level for the development of “event” was evaluated. As a secondary outcome of the study, the frequency of TTE findings was recorded. RESULTS: NT-proBNP level of the patients who developed event within 30 days had significantly higher than who did not (2343.16 ± 4107.17 pg/mL vs. 843.22 ± 2349.96 pg/mL, P = 0.001). A high negative correlation was found between NT-proBNP level and “time to event” (r = −0.992, P CONCLUSION: NT-proBNP level is a strong predictor for short-term prognosis of patients hospitalized with COPD exacerbation. Further and larger studies are needed to determine exact role of NT-proBNP in long-term prognosis of these patients.

P1686Natriuretic peptides personifying role in patients with arterial hypertension and chronic heart failure

Abstract Aim The aim of research was to study NT-proBNP in patients with arterial hypertension (AH) and chronic heart failure (CHF). Object and methods of research 420 male patients in age from 30 to 60 years old were examined: group 1 (n=180) – patients with AH without CHF, group 2 (n=86) – patients with AH and CHF, group 3 (n=74) – patients with CHF without AH and the group of control (n=80). NT-proBNP, fmol/ml, was measured. Results NT-proBNP had the highest levels in patients of group 3 in comparison with the group of control (p=0.046), group 1 (p=0.037) and group 2 (p=0.046). The duration of AH didn't affect the level of NT-proBNP (r=0.186; p=0.537). In the group with AH, the plasma level of NT-proBNP was lower in patients with 2 and 3 degrees of AH compared with patients with 1 degree of AH (p&lt;0.05). In the group of patients with AH and CHF this pattern wasn't observed (p&gt;0.05). NT-proBNP was interrelated with AH degree in group 1 (r=−0.624; p=0.023). Such a relationship wasn't established in group 2 (r=0.151; p=0.294), NT-proBNP was interrelated with NYHA functional class of CHF (r=0.215; p=0.049). The diagnostic value of changes in the level of NT-proBNP in the diagnosis of grade 1 AH relative to 2–3 degrees of AH in patients without CHF: at the point of separation (cut off) 3.85 fmol/ml, sensitivity 83% and specificity of 71%. ROC-area under curve = 0.81. The quality of the model was very good. NT-proBNP determining diagnostic value analysis to predict the enhancement in NYHA functional class of CHF in patients with AH and CHF: at a separation point of 3.4 fmol/ml specificity of 71%, sensitivity – 76%. ROC-area under curve = 0.74. We investigated the level of NT-proBNP in patients of groups 1 and 2 with different types of circadian blood pressure (BP) profiles. NT-proBNP levels were the highest in patients with “non-dipper”, “night-peaker” circadian blood pressure profile and differed significantly from patients profiles “dipper” and “over-dipper” as for systolic BP and for diastolic BP. Data correlation analysis revealed the inverse relationship between NT-proBNP and SBP (r=−0.498; p=0.035). Since there were no patients with circadian profiles “night-peaker” and “over-dipper” in group 1, and the results of the study reflected the level of NT-proBNP in group 2, we studied the level of these hormones in patients with the same type of circadian profiles in group 1 and group 2. The level of NT-proBNP in patients of group 1 with “non-dipper” profile was reduced in comparison with patients of group 2 and “dipper” circadian profile. Conclusion Determination of natriuretic peptides in patients with AH and CHF personifies the diagnosis and prognosis of cardiovascular complications. Natriuretic peptides are involved in circadian blood pressure profile.

Implications of N-terminal pro-B-type natriuretic peptide in patients with three-vessel disease.

Risk assessment and treatment stratification for three-vessel disease (3VD) remain challenging. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an established biomarker for prognostication and treatment in heart failure. The present study aimed to evaluate the prognostic value of NT-proBNP beyond the SYNTAX score II (SSII), and its association with long-term outcome after three strategies [percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and medical therapy (MT)] in a cohort of patients with 3VD. A total of 6597 patients with available baseline NT-proBNP data were included in the study. Baseline, procedural, and follow-up data were collected. The primary endpoint was all-cause death. Secondary endpoints included cardiac death and major adverse cardiac and cerebrovascular events (MACCE), a composite of death, myocardial infarction, and stroke. During a median follow-up of 7.0 years, higher NT-proBNP levels were strongly associated with increased risks of all-cause death, cardiac death, and MACCE (all adjusted P < 0.01). Moreover, NT-proBNP significantly improved discrimination and reclassification of the SSII. Notably, there was a significant interaction between NT-proBNP quartiles and treatment strategies for MACCE (P = 0.004). Revascularization was associated with lower risks of MACCE than MT, except for patients in the lowest quartile wherein no such association was observed. Among patients in the highest quartile, PCI was associated with an increased risk of MACCE compared with CABG (hazard ratio 1.43, 95% confidence interval 1.09-1.87). N-terminal pro-BNP is a potential biomarker for risk stratification and therapeutic decision-making in patients with 3VD. Further randomized studies are needed to confirm these findings.

High Serum Uric Acid is Highly Associated with a Reduced Left Ventricular Ejection Fraction Rather than Increased Plasma B-type Natriuretic Peptide in Patients with Cardiovascular Diseases

High serum uric acid (UA) has been reported to be associated with left ventricular (LV) dysfunction; however, the relationship between UA and plasma B-type natriuretic peptide (BNP), a sensitive biomarker of heart failure, is still unclear. This study investigated their relationship to provide an accurate assessment of high UA. The study patients consisted of 3,077 subjects who underwent cardiac catheterization because of various cardiovascular disorders. Since the explanatory factors of multiple regression analysis were mostly confounding with each other, subgroup analysis was performed by quartering the study population using the respective risk factors and by covariance structure analysis. This analysis revealed that UA was almost always well associated with a reduced LV ejection fraction (LVEF), but generally not with BNP. UA was significantly associated with BNP in lean aged females, but not in obese adolescent males, although LVEF was significantly reduced in response to a high UA in both groups. A high UA is a direct risk factor for cardiac dysfunction from the perspective of BNP; however, augmentation of BNP in response to a high UA would likely be restricted among obese adolescent males. On the other hand, the observed LV systolic dysfunction, such as LVEF, reflects a high UA on an almost constant basis.

Serum levels of carbohydrate antigen 125 in combination with N-terminal pro-brain natriuretic peptide in patients with acute decompensated heart failure.

Background/AimsCarbohydrate antigen 125 (CA-125) is an emerging prognostic biomarker for heart failure. We aimed to test the long-term prognostic value of CA-125 in combination with N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute decompensated heart failure (ADHF).MethodsThis observational study included a total of 413 patients (64.1 ± 15.6 yearold, 214 men) with ADHF. All-cause mortality during the 2-year follow-up was investigated for the prognosis.ResultsDuring the follow-up (mean follow-up, 591 ± 233 days), 109 deaths (26.0%) were recorded. In the multivariable analysis model, CA-125 was an independent factor associated with all-cause mortality (log CA-125: hazard ratio, 1.23; 95% confidence interval, 1.02 to 1.48; p = 0.030) together with age, sex, New York Heart Association class, β-blocker, and NT-proBNP. The Kaplan-Meier survival analysis demonstrated that the group with both low marker levels showed the best 2-year survival (87.9%) followed by the group with low NT-proBNP and high CA-125 (76.1%), high NT-proBNP and low CA-125 (64.7%) and high NT-proBNP and high CA-125 levels (54.3%) (p < 0.001). Addition of CA-125 in combination with NT-proBNP and established risk factors further increased the predictive power for mortality in patients with ADHF.ConclusionsCA-125 was an independent factor associated with all-cause mortality in patients with ADHF. Combination of CA-125 with NT-proBNP significantly improved the prediction of mortality in patients with ADHF.