NT-pro Brain Natriuretic Peptide Research Articles

Exploring Acute Kidney Injury Following Aortic Dissection: A Comprehensive Review of Machine Learning Models for Predicting Risk, Management Strategies, Complications, and Racial and Gender Disparities.

Both types of aortic dissection (AD), Stanford type A and type B, can result in complications such as acute kidney injury (AKI) and aortic rupture. Renal complications in AD arise from compromised renal perfusion affecting the renal arteries. Understanding the intricate connection between AD and AKI is crucial for navigating the complexities of tailored treatment and formulating specific management plans. Concerning machine learning models, in patients with type A aortic dissection, factors such as decreased platelet count on admission, increased D-dimer level, longer cardiopulmonary bypass duration, elevated white blood cell levels, the need for blood transfusion, longer aortic clamp time, extended surgery duration, advanced age, and an elevated body mass index were positively associated with the development of AKI. For the risk of AKI after type B aortic dissection, elevated Nt-pro brain natriuretic peptide, prolonged activated partial thromboplastin time, elevated admission systolic blood pressure, and a higher contrast agent requirement during operative repair were found to predict the risk. Male gender was associated with a higher risk of AKI, and nonwhite race was linked to a higher risk of AKI, a greater likelihood of requiring more urgent procedures, and lower levels of insurance coverage. The treatment of AKI following AD requires a multifaceted approach. Identifying and addressing the underlying cause, such as low blood pressure, renal artery involvement, or medication-induced injury, is crucial for effective management and preventing further kidney damage. Maintaining proper fluid balance is essential for improving renal perfusion, but careful monitoring is necessary to avoid complications. The evolving landscape of research, particularly in biomarkers and AI programs, reveals a promising role in predicting the risk for and managing AKI post-AD.

The Role of Oxidative Stress and Inflammatory Parameters in Heart Failure

Heart failure (HF) remains a major medical and social problem. The NT-pro-brain natriuretic peptide (NT-proBNP) and its active form, brain-type natriuretic peptide (BNP), in a simple blood test are the gold-standard biomarkers for HF diagnosis. However, even good biomarkers such as natriuretic peptides fail to predict all the risks associated with HF due to the diversity of the mechanisms involved. The pathophysiology of HF is determined by numerous factors, including oxidative stress, inflammation, neuroendocrine activation, pathological angiogenesis, changes in apoptotic pathways, fibrosis and vascular remodeling. High readmission and mortality rates prompt a search for new markers for the diagnosis, prognosis and treatment of HF. Oxidative-stress-mediated inflammation plays a crucial role in the development of subsequent changes in the failing heart and provides a new insight into this complex mechanism. Oxidative stress and inflammatory biomarkers appear to be a promising diagnostic and prognostic tool in patients with HF. This systematic review provides an overview of the current knowledge about oxidative stress and inflammation parameters as markers of HF.

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).

Biomarkers for predicting atrial fibrillation: An explorative sub-analysis of the randomised SCREEN-AF trial

Background Atrial fibrillation (AF) is a common treatable risk factor for stroke. Screening for paroxysmal AF in general practice is difficult, but biomarkers might help improve screening strategies. Objectives We investigated six blood biomarkers for predicting paroxysmal AF in general practice. Methods This was a pre-specified sub-study of the SCREEN-AF RCT done in Germany. Between 12/2017-03/2019, we enrolled ambulatory individuals aged 75 years or older with a history of hypertension but without known AF. Participants in the intervention group received active AF screening with a wearable patch, continuous ECG monitoring for 2x2 weeks and usual care in the control group. The primary endpoint was ECG-confirmed AF within six months after randomisation. High-sensitive Troponin I (hsTnI), brain natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-pro BNP), N-terminal pro atrial natriuretic peptide (NT-ANP), mid-regional pro atrial natriuretic peptide (MR-pro ANP) and C-reactive protein (CRP) plasma levels were investigated at randomisation for predicting AF within six months after randomisation. Results Blood samples were available for 291 of 301 (96.7%) participants, including 8 with AF (3%). Five biomarkers showed higher median results in AF-patients: BNP 78 vs. 41 ng/L (p = 0.012), NT-pro BNP 273 vs. 186 ng/L (p = 0.029), NT-proANP 4.4 vs. 3.5 nmol/L (p = 0.027), MR-pro ANP 164 vs. 125 pmol/L (p = 0.016) and hsTnI 7.4 vs. 3.9 ng/L (p = 0.012). CRP levels were not different between groups (2.8 vs 1.9 mg/L, p = 0.1706). Conclusion Natriuretic peptide levels and hsTnI are higher in patients with AF than without and may help select patients for AF screening, but larger trials are needed.

Non-thyroidal Illness in Children with Congestive Heart Failure.

To estimate the proportion and risk factors of non-thyroidal illness (NTI) in children with congenital heart disease (CHD) with congestive heart failure(CHF). This study enrolled children (6 weeks to 60 months age) with CHD and CHF. The clinical profile and disease severity using Pediatric Early Warning Score (PEWS) was recorded. Baseline blood samples were taken within 24hours of hospitalization and evaluated for fT3, fT4, TSH, NT pro-Brain natriuretic peptide (NT pro-BNP) and reverseT3. A total of 80 (64 acyanotic CHD) children of median (IQR) age 5 (2.5, 8.0) months were enrolled. NTI was seen in 37 (46%)- 27 with low fT3 levels. The proportion of NTI was maximum in children with severe disease (20/30), than moderate (4/9) or mild disease (13/41); p=0.018. Ten (27%) patients with NTI expired as compared to 2 (4.7%) without NTI with unadjusted odds ratio (95% CI) 7.593(1.54, 37.38); p-value=0.006. After adjusting for NTI, shock and NT-pro-BNP levels, PEWS was the only significant predictor of mortality (OR 1.41, 95% CI 1.03, 1.92; p=0.032).Linear regression for fT3 showed significant relation with log NT-BNP [beta -3.541, (95% CI -1.387, -0.388)] and with TSH [beta 2.652 (95%CI 0.054, 0.383)]. The cutoff (AUC, 95%CI) that predicted mortality were fT4 <14.5 pmol/L (0.737, 0.60, 0.88), fT3/rT3 index <1.86 pg/ng (0.284, 0.129, 0.438) and NT pro-BNP >3725 pg/mL (0.702; 0.53, 0.88). NTI was seen in a significant proportion of children with CHD and CHF. Free T3 level was significantly affected with NT-BNP levels (severity of CHF).

Supervised exercise training in patients with cancer during anthracycline-based chemotherapy to mitigate cardiotoxicity: a randomized-controlled-trial.

Exercise training (ET) has been shown to mitigate cardiotoxicity of anthracycline-based chemotherapies (AC) in animal models. Data from randomized controlled trials in patients with cancer are sparse. Patients with breast cancer or lymphoma receiving AC were recruited from four cancer centres and randomly assigned to 3 months supervised ET. Primary outcome was change in left ventricular global longitudinal strain (GLS) from baseline (before AC) to post AC (AC-end) compared between the EXduringAC group, who participated in an exercise intervention during AC including the provision of an activity tracker, and the control group EXpostAC, who received an activity tracker only. Secondary outcome parameters were changes in high sensitivity Troponin T (hsTnT), NT-pro-brain natriuretic peptide (NT-proBNP), peak oxygen consumption (peak VO2) and objectively measured physical activity (PA) during this same time-period. All assessments were repeated at a 12-week follow-up from AC-end, when also the EXpostAC group had completed the ET, that started after AC. In exploratory analyses, robust linear models were performed to assess the association of PA with changes in echocardiographic parameters and biomarkers of LV function. Fifty-seven patients (median age 47 years; 95% women) were randomized to EXduringAC (n = 28) and EXpostAC (n = 29) group. At AC-end, GLS deteriorated in both study groups (albeit insignificantly) with 7.4% and 1.0% in EXduringAC (n = 18) and EXpostAC (n = 18), respectively, and hsTnT and NT-proBNP significantly increased in both groups, without difference between groups for any parameter. Change in peak VO2 (-1.0 and -1.1 ml/kg/min) at AC-end was also similar between groups as was duration of moderate-to-vigorous PA (MVPA) with a median of 33 [26, 47] min/day and 32 [21, 59] min/day in the EXduringAC and EXpostAC group, respectively. In the robust linear model including the pooled patient population, MVPA was significantly associated with a more negative GLS and lesser increase in hsTnT at AC-end. In this small scale RCT, supervised ET during AC was not superior to wearing a PA tracker to mitigate cardiotoxicity. The dose-response relationship between PA and cardioprotective effects during AC found in our and previous data supports the notion that PA should be recommended to patients undergoing AC. ClinicalTrials.gov, identifier NCT03850171.

Right ventricular global work efficiency provides the highest prediction for improvements in right ventricle to left ventricle diameter ratio with acute pulmonary embolism treatments

Abstract Introduction In addition to standard echocardiographic measures, global longitudinal strain (GLS) with speckle tracking (ST) and myocardial work (MW) evaluation have been used in the assessment of right ventricle (RV) function in patients with acute pulmonary embolism (PE). In this study we aimed to compare echocardiographic measures, ST and MW in prediction of change in right ventricle (RV) to left ventricle (LV) diameter ratio (r) with treatments. Methods Our study comprised 83 consecutive patients (female %54.6, age 59±14.9 years) who admitted to our hospital with diagnosis of acute PE and underwent evidence-based treatments. Echocardiographic evaluation including ST and MW were performed within first 24 hours of admission. NT-pro-brain natriuretic peptide (NT-proBNP), troponin, pulmonary embolism severity index (PESI) and Qanadli score, RV and LV global work index (GWI), global work efficiency (GWE), global constructive work (GCW) and global wasted work (GWW), and RV-GLS were evaluated. Primary end-point (PEP) of this study was the change in RV to LVr on computed tomography (CT), and generalized additive model (GAM) in addition to classical linear regression (LR) were utilized for prediction of change in RV/LVr with these measures. Results PESI score and RV/LVr at admission were 84.8±23.8 and 1.13±0.39, respectively. Unfractioned or low-molecular weight heparin were treatments of choice in patients. The change in RV/LVr after selected treatments were 0.356. Mean hospital stay and overall follow-up duration were 8.7±3.7 and 328.7±126.8 days, respectively. In-hospital and long-term mortality rates were 1.2% and 13.3% respectively. Correlation co-efficients for intra- and interobserver agreement of MW measures varied from 0.85 to 0.96. The LR revealed that pulmonary arterial systolic, diastolic and mean pressure estimates, fractional area change and RV annular tissue velocity were significantly related with changes in RV/LVr (p values; 0.02, 0.01, 0.004, 0.03 and 0.03, respectively). Moreover, RV-GWE compared with RV-GLS showed a higher prediction for improvements in the RV/LVr (p value were &amp;lt;0.001 and 0.049, respectively). Utilization of GAM increased R2 value (from 0.15 to 0.20), and decreased the complexity of model. RV-GWE showed a moderate correlation with RV-GLS (r=-0.56), RV-GWI (r = 0.42), RV-GCW (r=0.32), LV-GWW(r=-0.55), LV-GLS (r=-0.33), FAC (r=0.26), NT-proBNP (r=-0.38), troponin (r=-0.28) but not with other measures. Conclusions The RV GWE as a novel myocardial work parameter seems to provide a better prediction for improvements in the RV/LVr with acute PE treatments as compared to clinical, laboratory and other echocardiographic measures including GLS.Figure-1Figure-2

The diagnostic value of global longitudinal strain combined with cardiac biomarkers on early detection of anthracycline-related cardiac dysfunction.

Cardiac dysfunction associated with anthracyclines is a significant side effect of chemotherapy, and early detection is crucial. We aimed to assess the diagnostic value of combining global longitudinal strain (GLS) with biomarkers for the early detection of anthracycline-related cardiac dysfunction. In a prospective cohort study, 80 consecutive adult patients (mean age 51 ± 11years; 68.8% females) were screened and underwent 2D echocardiographic assessments and biomarker assessments [high-sensitivity troponin-I (hs-Troponin-I) and NT-pro brain natriuretic peptide (NT-proBNP)] before and after anthracycline-based chemotherapy's initial regimen. The patients were followed up for 12weeks to monitor for the development of cardiotoxicity. Ten patients (12.5%) developed cardiotoxicity at the end of the 12-week follow-up. Baseline values of hs-Troponin-I and NT-proBNP were significantly higher in patients who developed cardiotoxicity compared to those who did not, with a similar pattern observed at the 3-week follow-up. Receiver operating characteristic (ROC) curve analysis demonstrated that a cutoff value of baseline hs-Troponin-I > 11ng/L, NT-proBNP > 90.1pg/mL, 3-week left ventricular ejection fraction (LVEF) ≤ 52%, 3-week GLS ≥ -14.5%, 3-week hs-Troponin-I > 13.1ng/L, and 3-week NT-proBNP > 118.1pg/mL predicted the occurrence of cardiotoxicity with high sensitivity (range 83-94%) and specificity (range 77-92%). Combination of GLS with biomarkers had a high diagnostic value in early identification of anthracycline-related cardiac dysfunction, with an estimated diagnostic accuracy of over 85%. This information could potentially help in the identification of patients at high risk of developing cardiac dysfunction, allowing for earlier management.

Evaluation of preterm infants having bronchopulmonary dysplasia with echocardiography and serum biomarkers.

Pulmonary hypertension is frequent in infants with bronchopulmonary dysplasia. Echocardiography is easy to perform, non-invasive, and recommended by guidelines even though solely it is not enough. Catheterisation is gold standard but invasive, expensive, and not cost effective. Therefore, we aimed to assess to find out the role of biomarkers besides echocardiography in the diagnosis of pulmonary hypertension in preterm with bronchopulmonary dysplasia. This study is done during the time period January 2016-2017. The diagnosis of pulmonary hypertension was assessed by echocardiography at 36 weeks later repeated at 3rd and 6th months. We also repeated biomarkers at 3rd and 6th months. The infants born ≤ 28 weeks in Erciyes University hospital who were diagnosed bronchopulmonary dysplasia were included. Infants with genetic syndromes, structural lung, and CHDs were excluded. Patients without bronchopulmonary dysplasia but having pulmonary hypertension due to other reasons and patients having echocardiograms without adequate images were excluded. At initial, 21/59 patients had bronchopulmonary dysplasia-pulmonary hypertension (Group 1), 21/59 had no bronchopulmonary dysplasia-pulmonary hypertension (Group 2), and 17/59 had bronchopulmonary dysplasia without pulmonary hypertension (Group 3). Systolic pulmonary artery pressure and pulmonary vascular resistance were found high in Group 1 (36 mmHg; p <0.001, 1.25 Woods Unit; p < 0.0017, respectively). Tricuspid annular plane systolic excursion values of Group 1 were low. Median serum kallistatin levels of Group 1 were lower than the other groups (230.5 (114.5-300.5) µg/ml; p < 0.005). During the study period, pulmonary hypertension of 14/21 bronchopulmonary dysplasia-pulmonary hypertension resolved, six patients in Group 3 developed pulmonary hypertension. However, there was no difference in the biomarkers of these six patients. In the diagnosis and the follow-up of pulmonary hypertension in bronchopulmonary dysplasia patients, besides echocardiography kallistatin, gelsolin, NT-probrain natriuretic peptide, homocysteine, and cystatin-C levels can be used. Further studies were required with large sample sizes.

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.

579 ACUTE ISCHEMIC HEART FAILURE: PHARMACOLOGICAL AND INTERVENTIONAL MANAGEMENT OF A FRAIL PATIENT

Abstract An 87-year-old male patient with worsening dyspnea was admitted to our institution. The patient had a history of acute myocardial infarction treated with coronary stenting of the left descending artery (LAD), diagonal (Diag), right coronary artery (RCA), and chronic kidney disease. For acute pulmonary edema, the patient was admitted to our cardiac intensive care unit and rapidly treated with non-invasive positive-pressure ventilation with continuous positive airway pressure (C-PAP), IV high dosage diuretic therapy, inotropes, and vasoactive agents. Chest X-ray revealed cardiomegaly (cardiothoracic ratio, 56%) and pulmonary congestion. Electrocardiogram revealed sinus tachycardia and diffuse ST-segment abnormalities. An echocardiogram demonstrated left ventricular apical akinesia, with a left ventricular ejection fraction (LVEF) of 25% and severe mitral regurgitation. Blood tests revealed very high levels of NT-pro-brain natriuretic peptide (NT-proBNP) (&amp;gt;30000 pg/ml) and myocardial necrosis markers (hs-Trop 5055 ng/l; CK-MB 72 ng/ml). After 24 hours, the patient was placed on intra-aortic balloon pump (IABP) support to further hemodynamic support through the right femoral artery, nonetheless, he showed no improvement in symptoms or urine output. Because of a state of hypoxemic and hypercapnic respiratory failure, non-invasive ventilation (NIV) was given to the patient with a gradual improvement in blood gas analysis. The optimization of diuretic therapy allowed to treat the state of acute oliguric kidney disease, avoiding dialytic treatment. After 48 hours, because of a new worsening in hemodynamic state, we decided for a percutaneous left ventricular assist device (Impella CP, Denver, Massachusetts, USA). After placing the Impella device, coronary angiography was performed, showing critical stenosis of the left main (LM), involving the origin of the left anterior descending artery and a collateralized chronic occlusion of the circumflex artery and the LAD, after the origin of a large first diagonal branch. Because of the high procedural risk, we decided to perform only percutaneous coronary intervention and stent implantation of LM. After 3 days his symptoms improved, the required dose of inotropic agents and furosemide decreased and Impella was removed. After 12 days the patient was admitted to the cardiological ward and discharged after 21 days because of a urinary infection requiring antibiotic therapy. The management of acute heart failure in very old patients is challenging, limiting in many cases the use of invasive procedures such as coronary angiography or left ventricular assist devices. In this case, although the patient presented a very high-risk profile considering age and comorbidities, the use of Impella resulted to be safe and guaranteed hemodynamic support during the procedure of revascularization and in the immediate post-operative phase.

Remote dielectric sensing to detect acute heart failure in patients with dyspnoea: a prospective observational study in the emergency department.

Remote dielectric sensing (ReDS) enables quick estimation of lung fluid content. To examine if ReDS is superior to other methods in detecting acute heart failure. We included consecutive patients with dyspnoea from the emergency departments at Bispebjerg Hospital, Copenhagen, and performed ReDS, low-dose chest computed tomography (CT), echocardiogram, lung ultrasound, NT-Pro-brain natriuretic peptide (NT-proBNP), and a Boston score evaluation (chest X-ray and clinical signs). ReDS values >35% were used as a cut-off to diagnose pulmonary congestion. Acute heart failure was adjudicated by experts' review of health records but independently of ReDS values. Sub-analyses investigated ReDS in acute heart failure patients with congestion on CT. We included 97 patients within a median of 4.8 h from admittance: 25 patients (26%) were ReDS-positive and 39 (40%) had adjudicated acute heart failure (21 with and 18 without CT congestion). Heart failure patients had median ReDS 33%, left ventricular ejection fraction 48%, and NT-proBNP 2935 ng/L. A positive ReDS detected heart failure with 46% sensitivity, 88% specificity, and 71% accuracy. The AUC for ReDS was like the Boston score (P = 0.88) and the lung ultrasound score (P = 0.74). CT-congested heart failure patients had higher ReDS values than patients without heart failure (median 38 vs. 28%, P < 0.001). Heart failure patients without CT-congestion had ReDS values like patients without heart failure (mean 30 vs. 28%, P = 0.07). ReDS detects acute heart failure similarly to the Boston score and lung ultrasound score, and ReDS primarily identifies the acute heart failure patients who have congestion on a chest CT.

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)

A Study of NT-ProBNP and ETCO2 in Patients Presenting with Acute Dyspnoea

Objectives: In patients presenting with acute dyspnoea in the emergency department (ED), the early and correct diagnosis may present a significant clinical challenge. The most common diagnoses of acute shortness of breath and manifesting signs of respiratory distress are decompensated heart failure (HF), pneumonia, chronic obstructive pulmonary disease (COPD), pulmonary embolism (PE), asthma, and acute respiratory distress syndrome (ARDS) and other causes like anaemia. The aim of the study was to measure NT-pro brain natriuretic peptide (BNP) and exhaled end-tidal carbon dioxide (ETCO2) in patients presenting with dyspnoea. Material and Methods: This prospective, cross-sectional and observational study was performed at the Government Medical College and Hospital, Nagpur, between October 2019 and October 2021 in patients admitted to the medicine intensive care unit. Three groups of patients were compared: (1) HF-related acute dyspnoea group (n = 52), (2) pulmonary (COPD/PE)-related acute dyspnoea group (n = 31) and (3) sepsis with ARDS-related dyspnoea group (n = 13). All patients underwent initial clinical examination with a recording of initial vital parameters along with on-admission ETCO2 measurement, NT-proBNP testing, arterial blood gas testing, lung ultrasound examination, 2D echocardiography, chest X-rays, and other basic diagnostic laboratory testing. Results: We included 96 patients during the study period. Median NT-proBNP was found to be maximum for the HF group (11,480 pg/ml) followed by the sepsis group (780 pg/ml) and pulmonary group (231 pg/ml). The mean ETCO2 value was found to be maximum in the pulmonary group (48.610 mmHg) followed by HF (31.51 mmHg) and the sepsis group (19.46 mmHg). All results were found to be statistically significant (P &lt; 0.05). Conclusion: NT-proBNP has high diagnostic accuracy in differentiating acute HF-related dyspnoea from pulmonary (COPD and ARDS)-related acute dyspnoea. The higher levels of ETCO2 help in diagnosing patients with COPD.

Differential Impact of Biologic Therapy on Heart Function Biomarkers in Rheumatoid Arthritis Patients: Observational Study on Etanercept, Adalimumab, and Tocilizumab.

Rheumatoid arthritis (RA) represents the most frequent form of inflammatory arthritis, affecting approximately 1% of the population worldwide. The introduction of novel therapeutic strategies targeting proinflammatory cytokines (TNF-α and interleukin-6) revolutionized the treatment of RA. This kind of treatment, although effective in a substantial portion of patients, may potentially cause many side effects. Among them, cardiovascular safety is one of the main concerns. In the present study, we investigated the impact of treatment with anti-TNF-α and anti-IL-6 agents on heart function and levels of heart function biomarkers. To measure this, we used cardiac function biomarkers, such as NT-pro Brain Natriuretic Peptide, mid regional pro-Atrial Natriuretic Peptide, Galectin-3, and Heart-Type Fatty Acid-Binding Protein and compared them to patients treated with methotrexate as well as healthy controls. Patients treated with biologics were characterized by low disease activity or were in remission. The disease activity in these groups was significantly lower than in the methotrexate group. All patients recruited for the study were characterized by normal heart function measured using echocardiography (EF>50%). With the exception of MR-proANP between tocilizumab and adalimumab (median: 1.01 vs. 0.49 nmol/L, p<0.05), we failed to observe any significant differences in biomarkers levels between groups treated with biologics. Contrary to this, patients on MTX showed higher NT-proBNP levels compared to adalimumab and healthy controls (p<0.05 for both). Striking differences have been shown in regard to H-FABP. The levels of these biomarkers were elevated in all biologics and the methotrexate group compared to healthy controls. As this biomarker reflects potential heart injury, we suggest that heart damage proceeds in a continuous manner in RA patients despite effective treatment and attainment of remission/low disease activity. This finding, however, should be verified in a larger cohort of RA patients to ascertain if the routine assessment of H-FABP may be useful for the detection of patients with RA who are at risk of development of heart damage.

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

Can cholesterol be too low? A retrospective correlation of cholesterol lab values to other markers of cardiovascular disease risk

Abstract Introduction/Objective Most recommendations for lipid panel reference ranges are one-sided (desirable total cholesterol is &amp;lt;200 mg/dL, optimal LDL cholesterol [LDL-C] is &amp;lt;100 mg/dL). However, recent studies suggest risks for cardiovascular diseases or mortality at very low cholesterol values. In this retrospective study, we investigated the association between lipid panel results and surrogate markers of cardiovascular disease to test the hypothesis that very low cholesterol levels are associated with increases in cardiovascular risk. Methods/Case Report Patients with lipid panels reported from April 2020-March 2021 at LAC+USC Medical Center were included. Lipid panels (total cholesterol, LDL-C, HDL-C, triglycerides) and laboratory results representing risk factors for cardiovascular disease (troponin T (TnT), NT-pro brain natriuretic peptide (BNP), hemoglobin A1c (HbA1c), high sensitivity C-reactive protein (CRP)) were collated. Lipid panel values were compared against the percentage of patients with non-optimal laboratory results for the cardiovascular risk markers. Results (if a Case Study enter NA) Decreasing total cholesterol levels vs. the percentage of patients with high TnT or BNP showed a U-curve with a nadir at 200-240 mg/dL (elevated TnT: 15%, BNP: 49%) and further increased with lower cholesterol levels &amp;lt;60 mg/dL (TnT: 56%, BNP: 92%); HbA1c (U-curve, nadir: 160-180 mg/dL); and CRP (90% at cholesterol &amp;lt;60 mg/dL; 43% at 220-240 mg/dL). Decreasing HDL-C against all markers of cardiovascular disease demonstrated a continued downtrend below optimal HDL-C levels. Decreasing LDL-C vs. the percentage of high TnT showed a U-curve with a nadir at 120-140 mg/dL; BNP (uptrends in the optimal range of LDL-C); HbA1c (U-curve, nadir: 90-100 mg/dL); and CRP (uptrends with decreasing LDL-C). TnT and BNP decreased with increasing triglycerides, while HbA1c increased with increasing triglycerides. Data points (TnT: n &amp;gt; 5,000; BNP: n &amp;gt; 3,000; HbA1c: n &amp;gt; 29,000; CRP: n &amp;gt; 4,500). Conclusion Very low concentrations of total cholesterol and LDL-cholesterol are associated with elevated markers of cardiovascular risk. Laboratories may wish to consider incorporating low ends to total cholesterol and LDL-cholesterol reference ranges.

Impact of afterload and infiltration on coexisting aortic stenosis and transthyretin amyloidosis

ObjectiveThe coexistence of wild-type transthyretin cardiac amyloidosis (ATTR) is common in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). However, the impact of ATTR and AS...

Prognosis of patients with acute pulmonary embolism and discordant right ventricle strain serum biomarkers

BackgroundRight ventricle strain serum biomarkers, such as high-sensitivity cardiac troponin T (hs-cTnT) and NT-pro-brain natriuretic peptide (NT-proBNP), are prognostic in patients with pulmonary embolism (PE). Prognosis accuracy in patients with discordancy between serum biomarkers remains, however, unknown. MethodsWe performed a retrospective analysis in patients with intermediate or high risk PE and discordant serum biomarkers of RV strain as follows: high hs-cTnT and low NT-proBNP (‘high troponin discordance’), compared to patients with low hs-cTnT and high NT-proBNP (‘high NT-proBNP discordance’). Cut-off values for high hs-cTnT were ≥14 pg/mL in patients <75 years and ≥45 pg/mL in patients >75-year. Cut-off values for high NT-proBNP were ≥600 pg/mL. The primary end-point was a composite of death, resuscitated cardiac arrest, mechanical ventilation, and inotrope use at one month. ‘High troponin discordance’, age, sex and body mass index (BMI) were included in a logistic regression model. Time to event analysis was performed using Kaplan Meier curves and Log-rank test. Results73 patients were included. ‘High troponin discordance’ patients (n=41) were younger, presented with a higher heart rate, more frequent bilateral PE, and received more thrombolytics as treatment compared with ‘high NT-proBNP discordance’ patients (n = 32). Primary end-point was significantly higher in the ‘high troponin discordance’ patients (29.3% vs 9.4%, p=0.045). ‘High troponin discordance’ was independently associated with the primary end-point after adjusting for age, sex and BMI. Log rank test confirmed worse outcome in the high troponin discordance group (p=0.037). ConclusionsHigh troponin discordance’ patients with intermediate/high risk PE, had worse outcomes than patients with high BNP discordance.

Factors related to the quality of life in patients with pulmonary arterial hypertension

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Pulmonary arterial hypertension (PAH) is a rare disease, with an incidence of 15–50 cases per million annually. The disease is associated with further progress and worsening of symptoms despite pharmacotherapy. The severity of PAH symptoms and their effects reduce the patients" quality of life (QoL). Numerous studies show that the quality of life is related to the therapeutic effect of the treatment. Available studies demonstrate that patients QoL deteriorates as the condition progresses. Consequently, the goals of PAH therapy have expanded from increasing survival to improving health-related quality of life. The aim of the study was to determine the clinical and sociodemographic factors influencing the quality of life in PAH patients. Methods The study involved 55 patients with PAH who were examined using the Polish version of the PAH-SYMPACT quality of life questionnaire. The PAH-SYMPACT questionnaire results were correlated with several variables. Results It was shown that the quality of life correlates significantly (p˂0,05) with WHO Functional Class, NT-pro BNP (N-terminal prohormone of brain natriuretic peptide) value, elderly age (the higher the value, the worse the QoL). On the other hand, the lower the 6MWT (6 minuts walk test) result, the worse the QoL. Moreover, the intensity of the accompanying PAH symptoms, such as chest pain, dyspnoea, arrhythmias, fatigue and weakness were associated with a lower quality of life in patients (p &amp;lt; 0,05). Conclusion Patients" quality of life correlates with many variables, both clinical and sociodemographic. In addition, there is a correlation between the quality of life of patients with PAH and the severity of several symptoms associated with this condition. Determination of factors affecting the quality of life of patients with PAH enables the selection of a more comprehensive therapy.