pro-BNP Levels Research Articles

Predictive Value of Pro-BNP for Heart Failure Readmission after an Acute Coronary Syndrome.

Background: N-terminal pro-brain natural peptide (NT-pro-BNP) is a well-established biomarker of tissue congestion and has prognostic value in patients with heart failure (HF). Nonetheless, there is scarce evidence on its predictive capacity for HF re-admission after an acute coronary syndrome (ACS). We performed a prospective, single-center study in all patients discharged after an ACS. HF re-admission was analyzed by competing risk regression, taking all-cause mortality as a competing event. Results are presented as sub-hazard ratios (sHR). Recurrent hospitalizations were tested by negative binomial regression, and results are presented as incidence risk ratio (IRR). Results: Of the 2133 included patients, 528 (24.8%) had HF during the ACS hospitalization, and their pro-BNP levels were higher (3220 pg/mL vs. 684.2 pg/mL; p < 0.001). In-hospital mortality was 2.9%, and pro-BNP was similarly higher in these patients. Increased pro-BNP levels were correlated to increased risk of HF or death during the hospitalization. Over follow-up (median 38 months) 243 (11.7%) patients had at least one hospital readmission for HF and 151 (7.1%) had more than one. Complete revascularization had a preventive effect on HF readmission, whereas several other variables were associated with higher risk. Pro-BNP was independently associated with HF admission (sHR: 1.47) and readmission (IRR: 1.45) at any age. Significant interactions were found for the predictive value of pro-BNP in women, diabetes, renal dysfunction, STEMI and patients without troponin elevation. Conclusions: In-hospital determination of pro-BNP is an independent predictor of HF readmission after an ACS.

Evaluation the relationship of left ventricular global longitudinal strain and laboratory parameters in discharged patients with COVID-19: a follow-up study.

Background: The novel coronavirus infection (COVID-19) disease has spread rapidly and posed a great threat to global public health. The laboratory parameters and clinical outcomes of the disease in discharged patients remain unknown. In this study, we aimed to investigate the laboratory and echocardiographic findings of patients with COVID-19 after discharge and the relation between left ventricular global longitudinal strain (LVGLS) and inflammatory parameters in discharged patients. Methods: A total of 75 patients recovering from COVID-19 as the study group were prospectively recruited from the COVID-19 outpatient clinic for their follow-up visits at a median 6 months after discharge. Patients were classified into groups according to pneumonia severity and impairment in LVGLS. Laboratory findings of patients both at admission and after discharge were evaluated and the relation with pneumonia severity at admission and LVGLS after discharge were analyzed. Results: Serum ferritin, lactate dehydrogenase (LDH) and prohormone B-type natriuretic peptide (pro-BNP) levels after discharge were significantly higher in the study group than the control group (n = 44). Ferritin was found to be related to pneumonia severity. Serum ferritin and LDH values after discharge were significantly higher in patients with impaired LVGLS than those with preserved. There was a significant correlation between LVGLS, serum ferritin and LDH values after discharge (r = −0.252, p = 0.012; r = −0.268, p = 0.005, respectively). Conclusions: Clinicians should pay close attention to the serum ferritin and LDH levels in discharged patients for predicting the severity of COVID-19 disease and early identification of subclinical left ventricular myocardial dysfunction.

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%).

Natriuretic Peptide Levels and Clinical Outcomes among Patients Hospitalized with COVID-19 Infection

PurposeThere is increasing evidence of adverse cardiovascular morbidity associated with SARS-CoV-2 (COVID-19). Pro-B-type natriuretic peptide (proBNP) is a biomarker of myocardial stress associated with outcomes in various respiratory and cardiac diseases. We hypothesized that proBNP level would be associated with mortality and clinical outcomes in hospitalized COVID-19 patients.MethodsWe performed a retrospective analysis of hospitalized COVID-19 patients (n=1232) using adjusted logistic and linear regression to assess the association of admission proBNP (analyzed by both categorical cutoff >125 pg/mL and continuous log transformed proBNP) with clinical outcomes. Covariates included age, sex, race, body mass index (BMI), hypertension, coronary artery disease (CAD), diabetes, smoking history, and chronic kidney disease stage (Model 1), with Troponin I added in Model 2. We performed survival analysis by a multivariate Cox proportional hazard model, incorporating log transformed proBNP. We additionally treated BMI, a strong potential confounder of both proBNP levels and COVID-19 outcomes, as an ordinal variable ordered across tertiles.ResultsPatients were mean age 62.9±17.6, 53.8% male, and 35.9% Black. Preadmission comorbidities were hypertension (57.1%), diabetes (31.6%), CAD (9.0%) and heart failure (HF, 10.6%). In Model 1 and 2, higher proBNP level was significantly associated with death, new HF, length of stay, ICU duration and need for ventilation among hospitalized COVID-19 patients. This significance persisted after ordinal compression of BMI across tertiles. The adjusted hazard ratio of death for log[proBNP] was 1.56 (95% CI: 1.23-1.97; P<0.0001).ConclusionUsing a relatively large and racially diverse hospitalized COVID-19 patient cohort, we find that proBNP is associated with adverse clinical outcomes, including mortality and new HF in COVID-19. Further prospective investigation is warranted on the utility of proBNP for clinical prognostication in COVID-19.

Rapid Clinical Recovery from Critical COVID-19 Pneumonia with Vasoactive Intestinal Peptide Treatment

IntroductionRLF-100 (Aviptadil), a synthetic form of human Vasoactive Intestinal Peptide (VIP), is in clinical trials for treatment of critical COVID-19 pneumonia with respiratory failure. VIP was shown to protect the lung against a broad array of injuries by binding to the VPAC1 receptor of alveolar type II (ATII) cells, the cells that SARS-CoV-2 binds to. The role of RLF-100 in treating lung transplant patients with COVID-19 pneumonia is unknown.Case ReportA 54 year old man with double lung transplant presented with headache, fever and productive cough. COVID-19 infection was confirmed by positive RT-PCR of nasopharyngeal swab. The patient required only supportive care for three days and was discharged home. Two weeks later he presented with worsening dyspnea, fever and severe hypoxemia requiring high flow O2 and ICU admission. Chest CT showed diffuse bilateral consolidations. He had markedly elevated inflammatory markers. He was treated with dexamethasone and tocilizumab without improvement. He was not a candidate for Remdesivir due to chronic kidney disease. Convalescent plasma was not available. Pro-BNP level was normal; echocardiogram showed preserved biventricular function. He received Aviptadil, a total of three doses, per an open label access under an emergency use approved by US FDA. Rapid improvement in oxygenation and radiologic findings were noticed. No adverse effects were recorded. The patient was transferred out of the ICU 24 hours following the third dose and discharged home on room air 15 days later.SummaryWe report a case of lung transplant recipient with critical COVID-19 pneumonia treated with RLF-100 chieving rapid clinical and radiologic improvement. This is consistent with that VIP protects ATII cells, ameliorating the inflammation and improving oxygenation in critical COVID-19 pneumonia. A randomized prospective trial is underway to evaluate the efficacy of RLF-100 in reducing mortality and improving oxygenation in patients with critical COVID-19 pneumonia.

Low Levels of Inflammation and Congestion at the First Outpatient Visit after LVAD Implant Predict Lower Risk for Readmission and More Days-Alive-out-of-Hospital

<h3>Purpose</h3> Inflammation and congestion persist after LVAD and may contribute to clinical outcomes. C-Reactive Protein (CRP) and N-terminal-pro B-type natriuretic peptide (proBNP) are established biomarkers of inflammation and congestion. We studied the association of these biomarkers measured at the first outpt visit after LVAD implant with: i) risk of readmission, and ii) days-alive-out-of-hospital (DAOH). <h3>Methods</h3> Serum CRP and proBNP were measured in LVAD pts implanted between 9/2014 and 11/2018. Readmissions and DAOH (based on % of total days) between first outpt visit and up to 2-year follow up were analyzed. CRP and proBNP values were categorized as ≥ vs < median. Freedom from readmission was evaluated by KM method. Cox proportional models were used to calculate hazard ratios (HRs) after adjusting for age, gender, INTERMACS≤2, and length-of stay during LVAD implant. <h3>Results</h3> 217 LVAD pts (99 HMII, 102 HM3, 16 others) were studied. 378 readmissions occurred in 155 pts. Median time to first readmission was 110 [29-233] d. Median DAOH% was 98.2% [94-100]. Median CRP and proBNP were 19.4 [8.9-43.6] mg/L and 1271 [456-3050] pg/mL. At 2-year follow up, freedom from readmission was higher in < vs ≥ median CRP (32.0% vs 23.2%, p=0.02) and in < vs ≥ median proBNP (30.5% vs 23.2% p=0.40), and was the highest in pts with both CRP and proBNP < median (42.2%, p=0.05) (Fig 1A). In adjusted Cox models, pts with both CRP and proBNP < median had significantly lower risk for readmission (HR 0.63, 95% CI 0.44-0.90, p=0.01). DAOH% was higher in pts with both CRP and NT-proBNP < median vs others (p=0.02, Fig 1B). <h3>Conclusion</h3> Low levels of CRP and proBNP at the first outpt visit identify a low-risk subset of LVAD pts with lower probability of readmission and higher DAOH%. Based on these findings, studies investigating interventions to reduce inflammation and congestion are needed to evaluate their impact on readmissions and quality of life.

162 Relationship Between NT Pro BNP Levels and Heart Failure in Patients &amp;gt;85 Years of Age

Abstract Introduction Around 920,000 people in the UK have been Diagnosed with Heart Failure with a median age of diagnosis been 77 years. The most commonly used test used to diagnose and measure prognosis in HF is BNP levels. B—Type Natriuretic Peptide is a hormone which is released in response to pressure changes in the ventricles. It causes Natriuresis which means removing sodium (salt) and water from the body thereby reducing the strain on the heart. It has a high negative predictive value to exclude heart failure with the following cut-off values. High levels—NTproBNP &amp;gt;2000 pg/ml. Raised levels—NTproBNP 400–2000 pg/ml. Normal levels—NTproBNP &amp;lt;400 pg/ml. The Aim of the study was to see if the cut off values of NT pro BNP Levels, which is the non-active pro hormone released from the same molecule that produces BNP are accurate in the elderly to diagnose Heart Failure. Method A retrospective study was carried out using 50 patients, age &amp;gt; 85 years with a diagnosis of heart failure. A comparison was made to look at NT pro BNP values and Ejection fraction (EF) [1] of these patients. A cut off of 50% EF was taken as diagnosing Heart Failure. Results Out of 50 patients, only 39 were suitable for the study as the rest did not have either a BNP value or an TransThoracic ECHO to assess Ejection Fraction. Age group taken was 85–97 years. 22.5% patients with a NT pro BNP level &amp;gt; 400 had an ejection fraction &amp;gt;50%. Conclusion Although we could only involve 39 patients, the data above shows that in patients aged &amp;gt;85 years with NT pro BNP values &amp;gt;400 around 25% have a normal ejection fraction. This suggest that increasing the cut off values for NT pro BNP to 750 in the elderly should be considered to diagnose Heart Failure, hence reducing cost and getting a high positive predictive value. Although more work is needed on the same. Reference 1. EF - in simple terms is amount of blood the heart is pumping into the body.

Clinical significance of NT-proBNP levels in Chronic Kidney Disease Patients with or without Heart Failure: An Indian Perspective

Objective: N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are extremely useful in detecting heart failure (HF). However, the effects of renal inadequacy on NT-proBNP levels in patients presenting with or without HF remains less clear. We sought to examine the correlation of NT-proBNP levels in all CKD patients and cut-off values of NT pro-BNP level for the diagnosis of HF in stable CKD patients as well as CKD patients who are on haemodialysis (HD). Material and Methods: The study comprises 141 CKD patients of both sexes who presented with or without dyspnea to casualty of Lilavati Hospital, Mumbai, India, were prospectively enrolled, and blood samples collected to estimate NT-proBNP level. Results: NT-proBNP cut-off level of 1850 pg/mL for stable CKD patients not on dialysis has a sensitivity of 95% and specificity of 80 %. NT-proBNP cut-off level of 8000pg/ml for CKD patients on HD has a sensitivity of 87 % and specificity of 79%. NT-proBNP cut-off level of 4200 pg/mL for all CKD patients has a sensitivity of 85% and specificity of 81%, for diagnosis of HF. Conclusion: The clinical use of NT-proBNP is a valuable tool for the evaluation of dyspneic patients with suspected HF, irrespective of renal function. We recommend the above NT-proBNP cut-off levels for diagnosing HF patients in the presence of impaired renal function. Evaluation of the correlation between NT-proBNP levels in CKD is important to identify and to design treatment modalities in order to reduce CVD .Therefore, NT-proBNP measurement can be a valuable tool for diagnosis and evaluation of dyspneic patients for early initiation of HF treatment.

Chronic CT features in PE patients with co-existing DVT.

Clinical features may be different in patients with PE without co-existing DVT compared to those with PE with co-existing DVT. This prospective study aims to investigate the different clinical features between patients with isolated pulmonary embolism (PE) and those with PE associated with deep venous thrombosis. This is a prospective study conducted in 107 consecutive patients diagnosed with acute PE in the emergency department or other departments of Kırıkkale University Hospital. The diagnosis of PE was confirmed by computed tomography pulmonary angiography (CTPA), which was ordered on the basis of symptoms and findings. Bilateral lower extremity compression ultrasound with standard 7.5MHz linear array probe was applied to all patients. According to compression ultrasound results, the patients were divided into two classes as with and without deep venous thrombosis. Embolism in the main or lobar pulmonary arteries were classified as central, and those found only in segmental or subsegmental arteries were classified as peripheral. Laboratory parameters and Oxygen saturation were assessed on admission. 67 of 107 (62.6%) patients with PE were isolated pulmonary embolism, and 40 (37.4%) were PE+DVT. Patients with PE with co-existing DVT have wider pulmonary artery, higher d-dimer and pro BNP level, and lower saturation than those with isolated pulmonary embolism. Central pulmonary embolism is more common in patients with deep vein thrombus than those without it. (87.5% (35/40) vs 32.8% (22/67),p=0.001). 38.6% of central pulmonary embolism occur without deep vein thrombosis of the lower extremities. Patients with PE with co-existing DVT have 42.5% mosaic perfusion pattern,70% chronic infarct appearance such as linear band, pleural nodüle, %15.0 thickened, small arteries and, %12.5 shrunken complete artery occlusion, suggesting the chronic background. PE patients with co-existing DVT are clinically more serious than those who do not have a DVT. An acute picture may be present in the chronic background in a significant proportion of patients with PE with co-existing DVT. In the presence of deep vein thrombosis, pulmonary embolism is usually central, but more than one-third of central pulmonary emboli occur without lower extremity deep vein thrombosis.

Is ProBNP a New Marker for Predicting Intrauterine Growth Restriction?

To evaluate the usability of first-trimester maternal serum ProBNP levels in the prediction of intrauterine growth restriction (IUGR). Methods In this prospective study, blood samples taken from 500 women who applied to our polyclinic for routine serum aneuploidy screening between the 11-14th gestational weeks were centrifuged. The obtained plasma samples were placed in Eppendorf tubes and stored at -80+°C. For the final analysis, first-trimester maternal serum ProBNP levels of 32 women diagnosed with postpartum IUGR and 32 healthy women randomly selected as the control group were compared. FGR was defined as estimated fetal weight below the 10th percentile for the gestational age. The mean ProBNP levels were statistically and significantly higher in the women with intrauterine growth restriction (113.73±94.69 vs. 58.33±47.70 pg/mL, p<0.01). At a cut-off level of 50.93, ProBNP accurately predicted occurrence of IUGR (AUC+= 0.794 (95% confidence interval 0.679-0.910), p+= 0.001) with sensitivity and specificity rates of 78.1 and 69.0%, respectively. Conclusion First-trimester serum ProBNP level was significantly higher in women who developed IUGR compared to healthy controls. First-trimester ProBNP level can be used as a potential marker to predict the development of IUGR in pregnant women.

Approach to decongestion therapy in patients with acute decompensated heart failure: the echocardiography guided strategy.

Goal The E / (Ea×Sa) index is an echocardiographic parameter to determine a patient's left ventricular filling pressure. This study aims to determine the safety and efficacy of the echocardiographic E / (Ea×Sa) index guided diuretic therapy compared to urine output (conventional) guided diuretic treatment.Material and Methods In this cross-sectional study, patients with heart failure with reduced ejection fraction (HFrEF) who were hospitalized due to acute decompensation episode were consecutively allocated in a 1:1 ratio to monitoring arms. The diuretic dose, which provided 20 % reduction in the E / (Ea×Sa) index value compared to initial value, was determined as adequate dose in echocardiography guided monitoring group. The estimated glomerular filtration rate (eGFR), change in weight, NT pro-BNP level and dyspnea assessment on visual analogue scale (VAS) were analyzed at the end of the monitoring.Results Although the similar doses of diuretics were used in both groups, the patients with E / (Ea×Sa) index guided strategy had the substantial lower NT pro-BNP level within 72 hours after diuretic administration (2172 vs.2514 pg / mL, p= 0.036). VAS score on dyspnea assessment was significantly better in the patients with E / (Ea×Sa) index guided strategy (52 vs. 65; p= 0.04). And, in term of body weight loss (4.93 vs.5.21 kg, p=0.87) and e-GFR (54.58±8.6 vs. 52.65±9.1 mL / min / 1.73 m2p=0.74) in both groups are associated with similar outcomes. In both groups, there was no worsening renal function and electrolyte imbalance that required stopping or decreasing loop diuretic dosing.Conclusions The E / (Ea×Sa) index guidance might be a safe strategy for more effective diuretic response that deserves consideration for selected a subgroup of acute decomposed HFrEF patients.

Elevated proBNP levels are associated with disease severity, cardiac dysfunction, and mortality in congenital diaphragmatic hernia

BackgroundCardiac dysfunction is a key determinant of outcome in congenital diaphragmatic hernia (CDH). Pro-b-type natriuretic peptide (proBNP) is used as a prognosticator in heart failure and cardiomyopathy. We hypothesized that proBNP levels would be associated with ventricular dysfunction and high-risk disease in CDH. MethodsPatients in the CDH Study Group (CDHSG) from 2015–2019 with at least one proBNP value were included. Ventricular function was determined using echocardiograms from the first 48 h of life. ResultsA total of 2,337 patients were identified, and 212 (9%) had at least one proBNP value. Of those, 3 (1.5%) patients had CDHSG stage A defects, 58 (29.6%) B, 111 (56.6%) C, and 24 (12.2%) D. Patients with high-risk defects (Stage C/D) had higher proBNP compared with low-risk defects (Stage A/B) (14,281 vs. 5,025, p = 0.007). ProBNP was significantly elevated in patients who died (median 14,100, IQR 4,377–22,900 vs 4,911, IQR 1,883–9,810) (p<0.001). Ventricular dysfunction was associated with higher proBNP than normal ventricular function (8,379 vs. 4,778, p = 0.005). No proBNP value was both sensitive and specific for ventricular dysfunction (AUC=0.61). ConclusionAmong CDH patients, elevated proBNP was associated with high-risk defects, ventricular dysfunction, and mortality. ProBNP shows promise as a biomarker in CDH-associated cardiac dysfunction.

Echocardiographic assessment of left ventricular filling pressure in patients with acute ST elevation myocardial infarction: an invasive validation study.

Backgrounds Assessment of left ventricular filling pressure (LVFP) is of clinical importance in patients with ST elevation myocardial infarction (STEMI). Although several echocardiographic parameters are recommended for the assessment of LVFP, validation of these parameters in patients with STEMI is missing. We aimed to investigate the clinical utility of these parameters in acute settings. Methods: We prospectively included consecutive patients with STEMI. LV end-diastolic pressure (LVEDP) was measured following primary PCI and echocardiographic examination was performed within 24 hours. Mean left atrial pressure (mLAP) was calculated both invasively using Yamamoto's formula and non-invasively using Naugeh's formula. Mean LAP was considered increased when exceeded 18mmHg. Results: Patients were grouped according to LVEDP, group 1(41 patients) and group 2(114 patients).There was no significant difference between groups in terms of comorbidities. NT pro-BNP levels (p < 0.001) and peak level of Hs-TnT (p-value: 0.002) were significantly higher in group 2. Average E/e' ratio was significantly higher in group 2 (10.19 ± 3.15 vs. 12.04 ± 4.83, p: 0.046). Isovolumetric relaxation time was longer in group 2 (p < 0.001) and left atrial volume index (LAVI) was also significantly higher in group 2 (p < 0.001). Regression analyses revealed that septal, lateral and average E/e' ratio, tricuspid regurgitation velocity, LAVI and left ventricular volume are correlated with mLAP. Among group 2 patients only 14 Patients fulfilled the increased LVFP criteria suggested by current guidelines. Conclusions Echocardiographic parameters indicating increased LVFP require validation and may need to be modified in patients with STEMI. Moreover, current algorithms underestimate the actual number of patients with increased LVFP.

Preventing Myocardial Injury Following Non-Cardiac Surgery: A Potential Role for Preoperative Antioxidant Therapy with Ubiquinone.

Over 240 million non-cardiac operations occur each year and are associated with a 15–20% incidence of adverse perioperative cardiovascular events. Unfortunately, preoperative therapies that have been useful for chronic ischemic heart diseases, such as coronary artery revascularization, antiplatelet agents, and beta-blockers have failed to improve outcomes. In a pre-clinical swine model of ischemic heart disease, we showed that daily administration of ubiquinone (coenzyme Q10, CoQ10) enhances the antioxidant status of mitochondria within chronically ischemic heart tissue, potentially via a PGC1α-dependent mechanism. In a randomized controlled trial, among high-risk patients undergoing elective vascular surgery, we showed that NT Pro-BNP levels are an important means of risk-stratification during the perioperative period and can be lowered with administration of CoQ10 (400 mg/day) for 3 days prior to surgery. The review provides background information for the role of oxidant stress and inflammation during high-risk operations and the potential novel application of ubiquinone as a preoperative antioxidant therapy that might reduce perioperative adverse cardiovascular outcomes.

The place of inferior vena cava diameter and proBNP levels in determining the fluid balance of medical intensive care patients

Objective: Fast and accurate detection of fluid balance in intensive care patients is of special significance. Many different methods are used to determine the fluid balance. In this study, we aimed to determine the fluid balance of patients in the medical intensive care unit using measurement of the inferior vena cava diameter and pro-brain natriuretic peptide (proBNP). Patients and Methods: Patients admitted to the medical intensive care unit between September 2013 and February 2014 were enrolled in the study. Inferior vena cava diameter was measured with a portable ultrasonography, according to guidelines published by the American Echocardiography Association. For pro BNP measurement, samples were taken simultaneously with ultrasonography. Results: One hundred and twenty-six patients (70 male,55.6%) were enrolled for the study. Mean age was 57.8 ± 19.8 (18-89 years). Nintey six (76.2%) patients were receiving mechanical ventilation support. Mean proBNP levels were 10645.88 ± 12731.08 pg/ml. There was no statistically significant difference between proBNP levels in patients according to the fluid status. Collapsibility index was not statistically different according to the volume status (p=0.75). Conclusion: proBNP levels were not correlated with the fluid balance. proBNP levels and inferior vena cava diameters were negatively but weakly correlated.

‘Digoxin conundrum – Time for validation?’

Despite no incontrovertible data, Digoxin use has been demonised. As a consequence, a lot of patients, stable on Digoxin, have been taken off it and offered alternative drugs. However, there is some light at the end of the tunnel for Digoxin, with the reporting of RATE-AF Trial at the recent European Society of Cardiology Congress. Compared to Bisoprolol, Digoxin use was associated with statistically significantly greater improvements in symptomatology and NT ProBNP levels making Digoxin a first line drug for rate control in permanent AF.

Evaluation of Echocardiographic Parameters for the Prediction of Prognosis in Patients Diagnosed with Pulmonary Arterial Hypertension

Background: We aimed to determine the importance of myocardial tissue Doppler flow rates, pulmonary artery/aorta diameter (PA/Ao), pulmonary venous flow transit time (pPTT), pulmonary artery acceleration time (PAAcTc), and right atrium area index (RAAI) parameters in the prediction of prognosis patients with a diagnosis of pulmonary arterial hypertension (PAH). Materials and Methods: : This retrospective study was done on 30 patients with systemic pulmonary arterial hypertension confirmed via catheterization who had negative vascular reactivity test results (pediatric patients with primary pulmonary hypertension and secondary pulmonary hypertension due to congenital heart disease). PA/Ao diameter, PAAcTc, pPTT, and RAAI were calculated. The patients were grouped as those with PA/Ao , SaO2% , and pro-B-type natriuretic peptide (BNP) , and those receiving combination therapy or monotherapy, and the parameters were compared between the groups. Results: pPTT was shorter in the group with SaO2 > 90%, which was attributed to the high number of patients with idiopathic PAH in this group and more severe PAH stage. PAAcTc was shorter in patients who showed no clinical improvement on monotherapy and required multidrug therapy. RAAI was significantly increased in patients with pro-BNP > 100 pg/ml. A decreased pPTT, accompanied by a lower PAAcTc in the group with PA/Ao >1.5, indicated the severity of PAH in this group. Conclusion: When managing PAH patients, the presence of RAAI > 18 cm2/m2, PA/Ao > 1.5, and PAAcTc < 80 msn indicates a higher disease severity, and suggested that the patients’ treatment regimen should be re-evaluated based on these parameters. Also, the RAAI parameter shows the closest association with pro-BNP levels, which is one of the correct prognosis indicators.

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.

Clinical Characteristics, Risk Factors and Cardiac Manifestations of Cancer Patients with COVID-19

Background: Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular features, which may be deteriorated in cancer patients.Methods: We retrospectively assessed 1,244 COVID-19 patients from February 1st to August 31st (140 cancer and 1104 non-cancer patients). Clinical data and laboratory findings were obtained and compared between cancer and non-cancer groups. Risk factors for in-hospital mortality were identified by multivariable COX regression models.Findings: The median age of cancer group was older than that in non-cancer patients [61 (57-67) vs. 56 (40-68), p Interpretation: COVID-19 cancer patients relate to deteriorating conditions, increased risk of admission to intensive care units and in-hospital mortality. They display severely impaired myocardium, damaged heart function and imbalanced homeostasis of coagulation, which warrants more aggressive treatment. Funding: The current work was supported by the National Natural Science Foundation Project of China (Grant No. 81670304) and the Fundamental Research Funds for the Central Universities of China (NO.2042019kf0058).Declaration of Interests: All authors report no relationship or conflict of interest to disclose.Ethics Approval Statement: This study was approved by the National Health Commission of China and the institutional review board at Renmin Hospital of Wuhan University (Wuhan, China).

N Terminal-Pro B Type Natriuretic Peptide (NT- PRO BNP) levels and severity of disease in elderly with heart failure

Background: Heart failure is a major health problem in the world. It is associated with high morbidity and high mortality especially in elderly patients. Most studies reported using N terminal pro-B type natriuretic peptide (NT-proBNP) in diagnosis of heart failure, but about of these tests in determining classification of severity of heart failure in the elderly remain unclear.Objective: To determine the differences NT-pro BNP levels based on the severity of diease of heart failure in elderly patients.Methods: This is an observational study with cross sectional design. Subjects were patients with diagnosed heart failure and aged = 60 years. Patients were divided into two groups, mild and severe heart failure groups according to severity of heart failure in New York Heart Association (NYHA) class. The NT Pro-BNP levels were measured for all subjects in both groups. Data was analyzed with using unpaired t test and was considered significant if p Results: This study involved 24 subjects, consisting of 2 gorups, there were mild heart failure groups (NYHA class I-II) and groups of patients with severe heart failure (NYHA III-IV). The mean age of the subjects was 64.50 ± 4.65 years with a minimum age of 60 years and a maximum of 78 years. The NT pro-BNP levels in the severe heart failure group (1.2587.58 ± 574.85 pg / ml) was higher than the mild heart failure group (867.83 ± 333.27 pg / ml), it was statistically significant with p = 0.040.Conclusion: The levels of NT-pro BNP serum in elderly patients with severe heart failure (NYHA III-IV) were significantly higher than in patients with mild heart failure (NYHA I-II).