NT-pro Brain Natriuretic Peptide Levels Research Articles

HEMODYNAMIC PARAMETERS AND STRUCTURAL CHANGES OF THE MYOCARDIUM IN PATIENTS WITH HEART FAILURE AND ATRIAL FIBRILLATION: THE ROLE OF BRAIN NATRIURETIC PEPTIDE, NT-PRO BNP, GALECTIN-3 AND sST-2

Heart failure remains one of the most common causes of hospitalization, disability, and mortality in the working population in the world, particularly in Ukraine; it has a high prevalence, an unfavorable prognostic course, and also causes significant economic costs. The prevalence of heart failure (HF) in the general population is 1.5 - 2.0%, and among people over 65 years old - 6 - 10% [10]. The main etiological cause of the development of chronic heart failure (CHF) is coronary heart disease (CHD), which is confirmed by the data of multicenter studies. One of the features of CHF is the high heterogeneity of its clinical manifestations and the absence of absolutely pathognomonic symptoms, which often leads to late diagnosis and deterioration of the prognosis of the course of the disease [1-6]. In the last decade, biomarkers for the diagnosis and prognosis of HF have been actively researched in search of the "ideal" one that can characterize the activation of all links of the HF syndrome and provide additional information about natriuretic peptides (NAUP). Given the extremely complex and multifaceted biochemical interactions that underlie the pathophysiology of CHF, scientists are paying more attention to a multimarker strategy for the diagnosis and risk stratification of CHF.Aim. The purpose of the paper is to investigate the role of brain natriuretic peptide (BNP), NT-pro BNP, galectin-3, s-ST2 in the development of heart failure in patients with atrial fibrillation.Material and methods. 468 patients aged 45-65 years (54,3±7,2 years) and 56 healthy people were included in the study. Among the examined were 234 (50,0%) women and 234 (50,0%) men. Group I – control, 56 practically healthy individuals; Group II - patients with CHF without AF (n=234); III group - patients with CHF and AF (n=234).Diagnoses of AF and HF were carried out according to the clinical protocol for providing medical care to patients with atrial fibrillation and heart failure, confirmed by the order of the Ministry of Health of Ukraine №436 of 07.03.2006. and according to the 2021 Recommendations of the European Society of Cardiology (ESC) on the diagnosis and treatment of acute and chronic heart failure. In addition to the general clinical examination, an enzyme immunoassay was also performed to determine the content of brain natriuretic peptide, NT-pro BNP, galectin-3 and sST-2 in the blood.Results. The analysis of structural changes of the myocardium in various phenotypes of CHF revealed a probable increase in the transverse size of the left atrium by 18,5%, the index of the size of the left atrium by 25,4%, the area of the left atrium by 25,3%, the volume of the left atrium by 21,6% and left atrial volume index by 10,1% in patients with CHF and concomitant AF.The study founds a probable increase in the levels of NT-pro BNP (by 50,1%; p<0,05) and brain natriuretic peptide (by 47,3%; p<0,05) in patients with AF and CHF. With an increase in the size of the left atrium against the background of CHF and AF, a probable increase in the concentration of galectin-3 (by 24.3%, p<0.05) and a probable increase in the level of sST-2 (by 41.4%, p<0, 05) were set. It has been proven that an important aspect of the phenotype of CHF with accompanying AF is the enlargement of the left atrium (LA), which probably correlates with the content of brain natriuretic peptide (BNP) (r=0,35; p<0,05), as well as with sST-2 content (r=0,41; p<0,05).

Subclinical dysfunction of remote myocardium is related to high NT-proBNP and affects global contractility at follow-up, independently of infarct area.

In ST-segment elevation myocardial infarction (STEMI), predictors of subclinical dysfunction of remote myocardium are unknown. We prospectively aimed at identifying clinical and biochemical correlates of remote subclinical dysfunction and its impact on left ventricular ejection fraction (LVEF). One-hundred thirty-three patients (63.9 ± 12.1 years, 68% male) with first successfully treated (54% anterior, 46% non-anterior, p = 0.19) STEMI underwent echocardiography at 5 ± 2 days after onset and at 8 ± 2-month follow-up, and were compared to 13 age and sex-matched (63.3 ± 11.4) healthy controls. All 16 left ventricular (LV) segments were grouped into ischemic, border, and remote myocardium: mean value of longitudinal strain (LS) within grouped segments were expressed as iLS, bLS, rLS, respectively. LV end-diastolic (EDV), end-systolic (ESV) volumes indexed for body surface area (EDVi, ESVi, respectively), LVEF and global LS (GLS) were determined. Creatinine, glomerular filtration rate, admission level of NT-pro-brain-natriuretic peptide (NT-proBNP) and troponin peaks were considered for the analysis. At baseline, rLS (15.5 ± 4.4) was better than iLS (12.9 ± 4.8, p < 0.001), but lower than that in controls (19.1 ± 2.7, p < 0.001) and similar to bLS (15 ± 5.4, p = ns), and did not differ between patients with single or multivessel coronary artery disease (CAD). At multivariate regression analysis, only admission NT-proBNP levels but not peak Tn levels independently predicted rLS (β = -0.58, p = 0.001), as well as iLS (β = -0.52, p = 0.001). Both at baseline and at follow-up, rLS correlated to LVEF similarly to iLS and bLS (p < 0.001 for all). Median value of rLS at baseline was 15%: compared to patients with rLS ≥ 15% at baseline, patients with rLS < 15% showed lower LVEF (52.3 ± 9.4 vs. 58.6 ± 7.6, p < 0.001) and GLS (16.3 ± 3.9 vs. 19.9 ± 3.2), and higher EDVi (62.3 ± 19.9 vs. 54 ± 12, p = 0.009) and ESVi (30.6 ± 15.5 vs. 22.3 ± 7.6, p < 0.001) at follow-up. In optimally treated STEMI, dysfunction of remote myocardium assessed by LS: (1) is predicted by elevated NT-proBNP; (2) could be independent of CAD extent and infarct size; (3) is associated to worse LV morphological and functional indexes at follow-up.

Outcomes of Heart Failure with Reduced Ejection Fraction Patients Receiving Sacubitril/Valsartan in Real-World Practice

Objective: To describe clinical outcomes and NT-pro-brain natriuretic peptide (NT-proBNP) level of patients with chronic heart failure with reduced ejection fraction (HFrEF) receiving sacubitril/valsartan (Sac/Val) in real world setting. Materials and Methods: The present research was a single-center, retrospective, non-interventional study in adult patients with HFrEF that received Sac/Val at Bhumibol Adulyadej Hospital. Data were extracted from the hospital’s database and electronic medical records. All patients fulfilling the inclusion criteria were identified and included into the present study. The present study was approved by the Ethics Committees of Bhumibol Adulyadej Hospital. Results: During the two years of the present study, two patients died from cardiovascularly (CV) death. The New York Heart Association (NYHA) class was changed from baseline to 12-month (2.0±0.4) and 24-month (1.8±0.1), p&lt;0.001. Left ventricular ejection fraction (LVEF) was significantly inclined at 24-month compared to baseline. The rate of heart failure and related hospitalization within one year declined from baseline at 19 visits/year to 12-month at 6 visits/year, and 24-month at 5 visits/year. The mean of NT-proBNP level was significantly reduced from baseline at 2,802.3±3,106.7 to 12-month at 2,203.8±4,051.1, and 24-month at 1,157.6±1,069.9 (p=0.03). Total hospitalization due to any cause was decreased from baseline at 26 visits/year to 12-month at 24 visits/year, and 24-month at 12 visits/year. Numbers of emergency room visit, ICU/CCU admission, length of stay for admission, and direct medical cost of heart failure (HF) treatment were diminished from baseline. Conclusion: Sac/Val can reduce hospitalized HF and level of NT-proBNP. Its efficiency in Thai patients with HFrEF was similar to real world data. Keywords: Heart Failure with reduced ejection fraction, Sacubitril/Valsartan, Angiotensin receptor blocker/neprilysin inhibitor (ARNI)

Prognostic value of NT-pro Brain Natriuretic Peptide levels in patients with AECOPD in Intensive Care Unit

Prognostic value of NT-pro Brain Natriuretic Peptide levels in patients with AECOPD in Intensive Care Unit

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%).

Applicability of GWTG Score to Heart Failure Patients in South India

Abstract Background The get with the guidelines (GWTG) risk score was developed to predict in-hospital mortality in acute heart failure patients. We aimed to clarify the prognostic impacts of the GWTG risk score in the south Indian heart failure patients admitted to intensive cardiac care unit (ICCU) in our hospital. Aim Our primary aim was to see the applicability of predicted GWTG risk score of heart failure in the south Indian heart failure patients admitted to intensive cardiac care unit (ICCU) of our hospital. Our secondary aim was to see the event rates and correlate predicted GWTG risk score of heart failure with in-hospital complications. Materials and Methods We included all the patients admitted to ICCU with the diagnosis of either ischemic or dilated cardiomyopathy over 6 months (January 2018 to June 2018). Indication for admission was either symptomatic heart failure (HF) or to evaluate cause for heart failure. We recorded the demographic and clinical parameters along with the ECG, 2D echo features, and relevant laboratory investigations. The GWTG risk score was based on seven parameters. Race, age, systolic blood pressure, heart rate, blood urea nitrogen (BUN) level, sodium concentration, and presence of chronic obstructive pulmonary disease (COPD) were used to predict in-hospital all-cause mortality, and in-hospital complications were noted. Results Out of 130 patients, 97 patients fulfilled the inclusion criteria. Out of them, 65 were males, with most of the patients between 40 to 80 years of age. Half the patients were diabetic and had abnormal electrocardiogram (ECG), and more than half were hypertensive, had clinically left ventricular failure (LVF) and diagnosed with ischemic cardiomyopathy (ICMP). Very few were smokers, and &lt; 30% were alcoholics, had abnormal liver function tests (LFT) and diagnosed with dilated cardiomyopathy (DCMP). Patients were divided into ICMP and DCMP patients, and all the variables were compared. Low systolic blood pressure (BP), abnormal ECG and the mean of GWTG score were greater in 22 patients afflicted with DCMP. However, abnormal renal functions with anemia and more NT-pro-brain natriuretic peptide (NT-proBNP) elevations were observed in ICMP HF patients. Out of 97 patients 70% patients had GTWG score of 34 to 50. There were no patients with score &gt; 58 in our study. Eighteen patients showed in-hospital complications. Five patients died with mean GWTG score 45.00, and they experienced cardiogenic shock with tachycardia and severe LV dysfunction (ejection fraction [EF] &lt; 15%), renal failure, hyponatremia, NT-proBNP levels &gt; 25,000 pg/dl and hepatic derangement at admission. A total of 92 patients were discharged with 39.02 mean GWTG score. There was a significant difference between the mean GWTG scores of patients in their final status (discharged/death) (p = 0.040). Also, patients with in-hospital complications had higher GWTG values (on an average 7 scores higher) than without complications (p = 0.000). Conclusions GWTG scores were able to predict (with statistical significance) the true end results for both complications during hospitalization and final discharge/death in hospitalized Indian HF patients. Higher GWTG Scores were an indication of complications or death (39 for complications and 45 for death seems to be the possible average values).

Effects of Aerobic Training and Garlic Extract Consumption on Serum ANP and NT-Pro BNP Levels in Obese Hypertensive Patients

Objectives: This study investigated the effects of an eight-week aerobic exercise program and use of garlic extract on serum atrial natriuretic peptide (ANP) and NT-pro brain natriuretic peptide (BNP) levels in obese hypertensive patients. Methods: A total of 50 male obese hypertensive patients with a mean age of 53 ± 7.6 years were recruited in this study. They were randomly assigned to five groups, including aerobic exercise, garlic extract, aerobic exercise + garlic extract, placebo, and control. The experimental groups were subjected to eight weeks of aerobic exercise (three sessions per week, each session for 35 - 60 min with a maximum heart rate of 50% - 70%) and/or garlic extract supplement (6 g daily). Blood samples were collected before interventions and 48 h after the last exercise session. Statistical analysis of data was performed by dependent t-test and Analysis of Covariance (ANCOVA). Results: Body weight, body mass index (BMI), systolic blood pressure, diastolic blood pressure, and NT-pro BNP in aerobic exercise, garlic extract, and garlic extract + aerobic exercise reduced significantly compared to control group (P ≤ 0.05). Body weight, BMI, and ANP decreased significantly in aerobic and aerobic + garlic extract groups compared to garlic group (P ≤ 0.001). Moreover, ANP reduced more significantly in aerobic exercise + garlic extract group than in aerobic exercise group (P ≤ 0.05). In addition, NT-pro BNP decreased more significantly in aerobic exercise + garlic extract group than in garlic extract group (P ≤ 0.01). Conclusions: It seems that both aerobic exercise and garlic extract are able to decrease obesity and hypertension. However, their simultaneous use has no additional effects on hypertension control although it influences the body composition and natriuretic peptides.

N-terminal pro-brain natriuretic peptide as a biomarker for differentiating cardiac and pulmonary disease in term neonates with respiratory distress.

ObjectiveBrain natriuretic peptide (BNP) is synthesized in the cardiac ventricles and released in response to volume or pressure load. The aim of the study was to determine whether plasma level of N-terminal pro BNP (NT-pro BNP) can distinguish between cardiac and pulmonary disease (PD) among neonates with respiratory distress (RD).Patients and methodsThe study included 48 term neonates in the first month of life with signs of RD. They were recruited from Neonatal Intensive Care Unit of Al-Galaa Teaching Hospital. Twenty-six healthy neonates were included as a control group. The degree of RD was assessed using Silverman–Anderson score. Chest X-ray, echocardiography, and laboratory measurement of NT-pro BNP were performed.ResultsAccording to the underlying disease, neonates with RD were divided into 28 neonates with PD and 20 neonates with congenital heart disease (CHD). Regardless the etiology of RD, NT-pro BNP was significantly higher in the RD group than in the control (p = 0.001). There was a significant difference between and within the three groups regarding NT-pro BNP (p = 0.001). NT-pro BNP was significantly higher in the CHD group than in the PD group (p = 0.001). There was a significant difference between and within RD subgroups. The NT-pro BNP is a very useful test for identification of CHD in neonates with RD. Area under the receiver operating characteristic curve for CHD was 0.857 (p = 0.01), sensitivity 66%, specificity 85%, and cutoff point was 24.5 pg/mL. The area under the curve for PD was 0.646 (p = 0.1) with poor sensitivity and specificity, indicating that NT-pro BNP is a poor test for identification of PD in neonates with RD.ConclusionTerm neonates with RD have increased plasma levels of NT-pro BNP. NT-pro BNP is a very good test for identification of CHD in neonates with RD, in comparison with PD. Therefore, plasma NT-pro BNP can be used to differentiate between cardiac and pulmonary cause of RD.

Plasma HbA1c in the investigation of suspected heart failure in general practice: An audit of the 2018 NICE guidelines update.

Introduction:Diabetes mellitus is a known risk factor for heart failure (HF); nevertheless, many HF patients remain undiagnosed. The National Institute for Health and Care Excellence in England updated their HF guidelines in 2018, replacing the use of fasting plasma glucose with glycated hemoglobin (HbA1c), in suspected HF investigation. This audit aimed to assess this update's uptake at a general practice partnership in Colchester, England.Materials and Methods:The audit cycle consisted of a two-round electronic record search, for approximately 29,000 patients registered at the partnership. From November 1, 2017 to November 1, 2018 for the first round and from November 1, 2018 to March 6, 2019 for the second round, patients who had their NT pro-brain natriuretic peptide levels measured for the initial investigation of suspected HF were included in the study. Interventions put in place after the first round included an oral presentation and an illustrated guide for the general practitioners (GPs).Results:One hundred and ten patients, 19 in cycle 1 and 91 in cycle 2, were identified and included in the analysis. At the first round, only 31.6% of the patients had their HbA1c level measured, while 36.8% had no diabetic investigation done. At the second round, the percentage of patients who had their HbA1c level assessed increased to 59.3%. A decrease from 36.8% of patients without diabetic status assessment to 20% was observed.Conclusions:Lack of awareness among GPs regarding this guideline update was identified and simple interventions achieved an increase in the guideline's uptake. Regular and complete audit cycles can help GPs adhere to up-to-date guidelines. Primary care can help other organizations such as pathology laboratories keep up to date with guidelines, while primary care technology can be amended in-house to help adherence to new guidelines. We recommend the National UK Heart Failure Audit considers auditing the use of HbA1c testing in inpatients investigated for new HF.

Utility of N-terminal pro-brain natriuretic peptide in detecting diastolic dysfunction in asymptomatic hypertensive patients: comparison with echocardiography.

Introduction: Data suggest that brain natriuretic peptide (BNP) and NT pro-BNP partially reflect ventricular pressure and could have a role in the early detection of diastolic abnormalities in hypertensive patients with normal systolic function. This study aimed to assess the role of NT pro-BNP for early detection of diastolic dysfunction in patients with hypertension and to correlate its level with echocardiographic parameters of diastolic dysfunction. Methods: This is a comparative cross-sectional study. Hundred cases of asymptomatic hypertensive patients with normal left ventricular (LV) systolic function and 100 healthy subjects were subjected to echocardiography and measurement of serum NT-pro BNP who received care at outpatient department of internal medicine, B.P. Koirala Institute of health sciences, Nepal. Results: Both systolic and diastolic blood pressures were significantly higher (≥160 and/or 100 mm Hg) in cases compared to controls (<120/80 mm Hg). Echocardiographic parameters of diastolic dysfunction: E/A ratio, E/E'ratio, deceleration time and isovolumetric relaxation time showed a significant difference between cases and controls. Mean serum NT-proBNP was significantly higher in patients with hypertension (213.19 ±184.3 pg/mL) compared to controls (58.51 ± 11.01 pg/mL) (P=0.008). There was no significant difference in mean serum NT-pro BNP levels between cases with no LV diastolic dysfunction (n=14) and controls (n=100) but it showed a significant difference between cases with LV diastolic dysfunction of all grades (n=86) and controls (n=100) (P=0.00). NT-proBNP levels were higher in both group of patients with E/A ratios <0.9 and 0.9-1.5 (245.72 ± 166.73 pg/mL and 210.69 + 143.53 pg/mL respectively) as compared to controls. Mean serum NT-proBNP levels were significantly higher in patients with IVRT >90 ms (270.43 ± 180.81 pg/mL) as compared to controls (P=0.03) but the difference was not significant between cases with IVRT of 60-90 ms (152.02 ± 100.23 pg/mL) and controls (P=0.09). NT-proBNP levels were significantly higher in all groups of patients with E/E' ratios <8, 8-12, >12 (197 ± 121.25 pg/mL, 263.12 ± 122.52 pg/mL and 180 ± 106.56 pg/mL respectively) compared to controls. Conclusion: Mean serum NT-proBNP was significantly higher in patients with hypertension as compared to controls. There is some correlation between echocardiographic parameters of diastolic dysfunction and serum NT-proBNP. Hence, NT-proBNP may be useful for early detection of LV diastolic dysfunction in patients with hypertension.

The relationship between serum NT-pro BNP and the severity of the COPD exacerbation

Introduction: COPD is a common preventable disease characterized by airflow limitation that is not completely reversible.Acute exacerbation is prominent and serious features of COPD. Acute Exacerbation of COPD leads to hospitalization and concomitant with morbidity and mortality .The ventricular dysfunction increases serum Brain Natriuretic Peptide(BNP) . This study was conducted to evaluate the relationship between serum N-terminal pro b-type natriuretic peptide (NT-pro BNP) level and the severity of chronic obstructive pulmonary disease (COPD) exacerbation. . Materials and Methods: This cross-sectional study was performed among 140 patients with COPD exacerbation referred to Imam Reza Hospital affiliated to Mashhad University of Medical Sciences, Mashhad, Iran from March 2016 to December 2017 . The patients were asked about the number of exacerbations over the past year including the recent attack. The severity of COPD was determined by the measurement of forced expiratory volume in 1 second by spirometery and level of hypoxemia by pulse oximetery. Data analysis was performed using SPSS software, version 20. Results: Regarding the results, COPD was more prevalent in males. The mean age of the patients was 57.60±9.76years old. There was a significant direct correlation between mean serum level of NT-pro BNP and age (P=0.01). Although mean serum NT-pro BNP level was higher in females patients (5.70±0.96) than males (5.66±1.24), no significant correlation was observed between mean serum NT-pro BNP level and gender (P=0.8). The most common chief complaints of the patients were dyspnea (97.9%), cough (88.9%), and phlegm (81.9%). There was no significant relationship between serum NT-pro BNP levels and the length of stay in hospital (P=0.1). However, there was a significant relationship between mean serum level of NT-pro BNP and COPD exacerbation (P=0.004). The mean serum level of NT-pro BNP was higher in the patients with more than two exacerbations over the last year in comparison to the other patients. Additionally, there was a significant direct relationship between mean serum level of NT-pro BNP and the severity of COPD (P=0.009). Moreover, a significant direct relationship was found between serum NT-pro BNP level and hypoxemia ( SpO2<90%; P=0.01). Furthermore, there was a significant relationship between mean serum level of NT-pro BNP and blood pH, which means that the mean serum level of NT-pro BNP was higher in the patients with blood pH levels of 7.25 and 7.25-7.30 (P=0.001). Conclusion: The serum NT-pro BNP level was a prognostic factor in the patients with COPD exacerbation.

Echocardiography is useful to predict postoperative atrial fibrillation in patients undergoing isolated coronary bypass surgery: A prospective study

Postoperative atrial fibrillation is a major complication following coronary artery bypass graft. We hypothesized that, beyond clinical and electrocardiogram (ECG) data, transthoracic echocardiography could improve the prediction of postoperative atrial fibrillation. We prospectively studied 169 patients in sinus rhythm who underwent isolated coronary artery bypass graft in our institution. Clinical, biological, ECG and transthoracic echocardiography data were collected within 24 h before surgery. The patients were continuously monitored during the first five days, and then had daily 12-lead ECG afterwards until discharge. Postoperative atrial fibrillation was defined by any episode >10 min. Postoperative atrial fibrillation was found in 65 patients (38%). Compared with those without, patients with postoperative atrial fibrillation were significantly older ( p=0.008), had more frequently a history of hypertension ( p=0.009), history of atrial fibrillation ( p<0.001) and New York Heart Association class ⩾III ( p=0.004). They also had longer PR interval ( p=0.005), higher preoperative NT-pro brain natriuretic peptide level ( p=0.006), left ventricle end-diastolic volume ( p=0.002), indexed left ventricle mass ( p<0.0001), indexed maximal left atrial volume ( p<0.0001), maximal right atrial area ( p<0.001) and lower left ventricle ejection fraction ( p=0.04). In multivariate analysis, history of atrial fibrillation (odds ratio =6.1, 95% confidence interval: 1.4-26.0, p=0.02) and indexed maximal left atrial volume (odds ratio =1.13, 95% confidence interval: 1.1-1.2, p=0.001) were the only two independent predictive factors of postoperative atrial fibrillation. The addition of echocardiographic parameters improved the predictive value (χ2) of the model, from 34 to 57. A history of atrial fibrillation and indexed left atrial maximal volume are the best predictors of the occurrence of postoperative atrial fibrillation following coronary artery bypass graft. The identification of high risk population of postoperative atrial fibrillation using these two factors could lead to the development of targeted strategies to limit this frequent complication in these patients.

Glucose tolerance and cardiovascular risk biomarkers in non-diabetic non-obese obstructive sleep apnea patients: Effects of long-term continuous positive airway pressure

BackgroundInsulin resistance, glucose dyshomeostasis and oxidative stress are associated to the cardiovascular consequences of obstructive sleep apnea (OSA). The effects of a long-term continuous positive airway pressure (LT-CPAP) treatment on such mechanisms still remain conflicting. ObjectiveTo investigate the effect of LT-CPAP on glucose tolerance, insulin sensitivity, oxidative stress and cardiovascular biomarkers in non-obese non-diabetic OSA patients. Patients & methodsTwenty-eight apneic, otherwise healthy, men suffering from OSA (mean age = 48.9 ± 9.4 years; apnea-hypopnea index = 41.1 ± 16.1 events/h; BMI = 26.6 ± 2.8 kg/m2; fasting glucose = 4.98 ± 0.37 mmol/L) were evaluated before and after LT-CPAP by an oral glucose tolerance test (OGTT), measuring plasma glucose, insulin and proinsulin. Glycated hemoglobin, homeostasis model assessment resistance insulin, blood lipids, oxidative stress, homocysteine and NT-pro-brain natriuretic peptide (NT-proBNP) were also measured. ResultsLT-CPAP treatment lasted 13.9 ± 6.5 months. At baseline, the time spent at SaO2<90%, minimal and mean SaO2 were associated with insulin area under the curve during OGTT (r = 0.448, P = 0.011; r = −0.382; P = 0.047 and r = −0.424; P = 0.028, respectively) and most other glucose/insulin homeostasis biomarkers, as well as with homocysteine (r = 0.531, P = 0.006; r = −0.487; P = 0.011 and r = −0.409; P = 0.034, respectively). LT-CPAP had no effect on all the OGTT-related measurements, but increased plasma total antioxidant status (+7.74%; P = 0.035) in a duration-dependent manner (r = 0.607; P < 0.001), and decreased both homocysteine (−15.2%; P = 0.002) and NT-proBNP levels (−39.3%; P = 0.002). ConclusionsIn non-obese non-diabetic OSA patients, nocturnal oxygen desaturation is strongly associated to insulin resistance. LT-CPAP does not improve glucose homeostasis nor insulin sensitivity but has a favorable effect on antioxidant capacity and cardiovascular risk biomarkers.

Late deterioration of left ventricular function after right ventricular pacemaker implantation.

Objectives:Right ventricular (RV) pacing induces a left bundle branch block pattern on ECG and may promote heart failure. Patients with dual chamber pacemakers (DCPs) who present with progressive reduction in left ventricular ejection fraction (LVEF) secondary to RV pacing are candidates for cardiac resynchronization therapy (CRT). This study analyzes whether upgrading DCP to CRT with the additional implantation of a left ventricular (LV) lead improves LV function in patients with reduced LVEF following DCP implantation.Methods:Twenty-two patients (13 males) implanted with DCPs and a high RV pacing percentage (>90%) were evaluated in term of new-onset heart failure symptoms. The patients were enrolled in this retrospective single-center study after obvious causes for a reduced LVEF were excluded with echocardiography and coronary angiography. In all patients, DCPs were then upgraded to biventricular devices. LVEF was analyzed with a two-sided t-test. QRS duration and brain natriuretic peptide (BNP) levels were analyzed with the unpaired t-test.Results:LVEF declined after DCP implantation from 54±10% to 31±7%, and the mean QRS duration was 161±20 ms during RV pacing. NT-pro BNP levels were elevated (3365±11436 pmol/L). After upgrading to a biventricular device, a biventricular pacing percentage of 98.1±2% was achieved. QRS duration decreased to 108±16 ms and 106±20 ms after 1 and 6 months, respectively. There was a significant increase in LVEF to 38±8% and 41±11% and a decrease in NT-pro BNP levels to 3088±2326 pmol/L and 1860±1838 pmol/L at 1 and 6 months, respectively.Conclusion:Upgrading to CRT may be beneficial in patients with DCPs and heart failure induced by a high RV pacing percentage.

B-type natriuretic peptide as a parameter for pulmonary hypertension in children. A systematic review.

Pulmonary hypertension (PH) is a life-threatening disease with a high mortality rate and a broad variety of underlying etiologies. The current golden standard for diagnosing PH and monitoring efficiency of treatment is right heart catheterization. As an alternative, serum biomarkers have been suggested. Cardiac troponin T (TnT), brain natriuretic peptide (BNP), and NT-proBNP seem the most potential. The aim of this systematic review was to evaluate the current literature on the prognostic value of these biomarkers in children with PH and their usefulness as a diagnostic tool. A systematic literature search yielded 14 studies on patients ≤18years with proven PH with (NT-pro)BNP or TnT as primary outcome. TnT is suggested to be a promising biomarker, but its usefulness in clinical practice has not been proven. The levels of (NT-pro)BNP seemed to be reliable within one PH category, but differed significantly between categories. NT-proBNP showed a good correlation with mortality and might have a prognostic value. The lack of absolute levels makes (NT-pro)BNP unsuitable as a diagnostic marker, but in view of the relative changes, it could be used to monitor patients. Further investigation should explore differences in normal (NT-pro)BNP levels between the different categories of PH. • Pulmonary hypertension is a life-threatening disease. Diagnosis can be challenging in children; the current diagnostic options-right heart catheterization and echocardiography-are invasive and/or investigator-dependent procedures. • Biomarkers could be useful in this context because they are investigator independent and easy to obtain through blood samples. Brain natriuretic peptide (BNP) and its N-terminal cleavage product (NT-proBNP) seem to be the most promising. The value of these biomarkers in the diagnostic approach of PH has already been investigated in adults, with promising results. Pediatric studies are still scarce. What is new: • The levels of BNP and NT-proBNP in pediatric patients differ strongly between the different categories of PH. Within the same category, the levels are more or less equal. • The relative changes could render them a prognostic marker in the follow-up of a certain individual patient. At this moment there is not enough evidence to rely on BNP or NT-proBNP in clinical treatment of patients with PH.

Tissue Doppler Imaging and Plasma N-Terminal Probrain Natriuretic Peptide for the Identification of Hypertrophic Cardiomyopathy Mutation Carriers

Previous studies have shown that tissue Doppler imaging (TDI) is able to identify mutation carriers of hypertrophic cardiomyopathy (HC) before the development of the clinical phenotype. However, data are scarce and have sometimes been controversial. We performed a systematic study that included conventional echocardiography, TDI, and plasma NT-probrain natriuretic peptide (NT-proBNP) measurement to evaluate the parameters that could identify HC mutation carriers. A total of 138 genotyped subjects were included and divided into 3 groups: group 1, those with HC (n= 62); group 2, mutation carriers (first-degree relatives with a positive genotype but negative phenotype; n= 34); and group 3, controls (first-degree relatives with a negative genotype and phenotype; n= 42). An echocardiographic study, including TDI, was performed on all subjects, and a TDI-derived index (global function index) was also determined. The age-adjusted mean differences in the echocardiographic and TDI parameters and NT-proBNP levels were compared among the 3 groups. Compared with the HC group, the carriers had significantly higher mean E' velocities, lower mean E/E' ratio, higher mean S' velocities, and lower mean global function index and NT-proBNP values. The carriers and controls did not differ significantly either in the echocardiographic parameters studied or in the NT-proBNP levels. In conclusion, the echocardiographic and TDI parameters and NT-proBNP levels cannot be used to identify the HC mutation carrier state and therefore do not appear to be reliable for the purpose of making a preclinical diagnosis of the disease.

β-Adrenergic Blockade for Anthracycline- and Trastuzumab-Induced Cardiotoxicity

Breast cancer is the second leading cause of cancer-related death among women in the United States.1 Approximately 25% to 30% of breast cancers have overexpression of human epidermal growth factor receptor 2 (HER2), which is associated with an adverse prognosis.2 Adjuvant chemotherapy with trastuzumab, the humanized monoclonal antibody that directly targets HER2, significantly improves disease-free and overall survival in these patients.3 However, trastuzumab, especially when given in combination with anthracyclines, has been associated with asymptomatic and symptomatic left ventricular (LV) dysfunction3 that can lead to premature discontinuation of trastuzumab therapy and significant cardiac morbidity. Article see p 420 In this issue of Circulation: Heart Failure , Seicean et al4 retrospectively evaluated the incidence of new symptomatic heart failure (HF) in patients with breast cancer treated with anthracyclines, trastuzumab, or both, at the Cleveland Clinic between 2005 and 2010. Using 1:2 propensity matching, they compared patients on continuous β-blockers during cancer treatment to those not on β-blockade, and assessed the effect of incidental β-blocker use on new symptomatic HF and noncardiac mortality during a median follow-up of ≈3 years. The results of this study show that trastuzumab, when given alone or in combination with anthracyclines, substantially increased the risk of symptomatic HF compared with anthracyclines alone (hazard ratio, 9.5; 95% confidence interval, 3.9–23.1). Furthermore, incidental β-blocker use significantly reduced the incidence of symptomatic HF (hazard ratio, 0.2; 95% confidence interval, 0.1–0.7) but did not affect noncardiac mortality in patients with breast cancer treated with trastuzumab, anthracyclines, or both. This article highlights 2 important issues: (1) it emphasizes the magnitude of trastuzumab cardiotoxicity in the real world, and (2) it provides support for the hypothesis that prophylactic β-blocker use may be cardioprotective in patients receiving trastuzumab, anthracyclines, or both. Anthracyclines cause a dose-dependent toxicity that is felt …

Clinical application value of NT-proBNP levels in evaluating dry weight of patients in maintenance hemodialysis

Objective To investigate the relationship between plasma NT-pro brain natriuretic peptide (NT-proBNP) levels and dry weight in patients in maintenance hemodialysis (MHD) and to evaluate the clinical value of NT-proBNP in the assessment of dry weight.Methods NT-proBNP level was determined in 18 cases of MHD patients with well-controlled dry weight and 20 eases of MHD patients with bad-controlled dry weight,while the latter would be checked once again after the weight was down-regulated to dry weight in 4 weeks.Results The average level of NT-proBNP was 3419.3(2368.7～5728.3) pg/ml which was higher than normal.Plasma NT-proBNP levels were significantly lower in patients with well-controlled dry weight than those patients with bad-controlled dry weight (2872.4 vs 4568.4) pg/ml,and there was very significant difference in plasma NT-proBNP levels between pre and post treatment of down-regulation to dry weight in patients with bad-controlled dry weight (4568.4 vs 2569.0) pg/ml.Conclusions Plasma NT-proBNP can be a good marker for the evaluation of dry weight in MHD patients. Key words: Hemodialysis; NT-proBNP; Dry weight

The relationship between adiponectin, NT-pro-BNP and left ventricular ejection fraction in non-cachectic patients with systolic heart failure: an observational study

NT-pro-brain natriuretic peptide (NT-proBNP) has been shown to be an accurate diagnostic marker in patients with heart failure (HF). Adiponectin (Adp) levels are increased in HF but its diagnostic value is still uncertain in these patients. The study was designed to investigate the possible association of these markers in non-cachectic patients with newly diagnosed systolic heart failure. Fifty-seven systolic HF patients and 20 matched controls were enrolled in an observational cross-sectional study. Physical and echocardiographic examinations were performed and serum Adp, NT-proBNP, tumor necrosis factor-alpha (TNF-α) levels were measured. Study variables were compared between the groups. Correlation analyses were done and the diagnostic validity of the markers was compared with ROC analysis. Adp and NT-proBNP levels were significantly higher in HF group (20.19±12.9 vs. 7.65±4.6 μg/mL; p<0.001 and 1051.74±606.2 vs. 222.53±65.6 pg/mL; p=0.002; respectively). TNF-α levels were similar between the groups (2.83±1.8 vs. 2.08±1.2 pg/mL; p=0.582). Correlation analysis showed significant association among Adp and NT-proBNP levels, (r=0.448; p<0.001), and left ventricular ejection fraction (LVEF) values (r=-0.466; p<0.001). The Adp and NT-proBNP showed comparable diagnostic performances with mean [95% confidence interval] areas under the curves of 0.857 (0.771-0.944) and 0.888 (0.815-0.960), respectively. There were significant correlation between Adp levels with NT-proBNP levels and LVEF values but no any association between Adp levels with body mass index values and TNF-α levels in patients with newly diagnosed systolic heart failure. The result may arouse suspicion about the hypothesis, which proposes that Adp levels simply reflects disease severity or cardiac cachexia in patients with HF.

Variants of Toll-like Receptor 4 Predict Cardiac Recovery in Patients with Dilated Cardiomyopathy

The clinical course of patients with dilated cardiomyopathy (DCM) varies from cardiac recovery to end stage heart failure. The etiology of this variability is largely unknown. In this study, we investigated the impact of coding polymorphisms of the innate immune protein Toll-like receptor 4 (TLR4) on left ventricular performance in patients with DCM. Two variants of TLR4 (rs4986790, TLR4 c.1187A→G, p.299D→G and rs4986791,TLR4 c.1487C→T, p.T399I) were investigated in 158 patients with DCM. Other reasons for heart failure were excluded by coronary angiography, myocardial biopsy, and echocardiography. Risk factors, age, gender, or treatment did not differ among the groups. At the follow-up evaluation (median 4.0-5.4 months), patients carrying the TLR4 wild type gene displayed cardiac recovery under intense medical heart failure therapy indexed by reduced left ventricular dilation, improved left ventricular ejection fraction, and reduced NT-probrain natriuretic peptide blood level when compared with the initial evaluation. In contrast, patients carrying both the rs4986790 and the rs4986791 variant showed significantly reduced improvement of left ventricular ejection fraction (p = 0.006) and left ventricular dilation (p = 0.015) at the follow-up evaluation when compared with carriers of the wild type gene under the same treatment conditions. In addition, NT-probrain natriuretic peptide level in carriers of both TLR4 variants did not change significantly at the follow up when compared with the first evaluation. Among patients with DCM, the presence of the TLR4 variants rs4986790 and rs4986791 predicts impaired cardiac recovery independently of medical treatment or cardiac risk factors.