pro-BNP Levels Research Articles

Serum Copeptin Level as a Predictor of One-Year Mortality after Acute Decompensated Heart Failure Hospitalization

Background: Acutely decompensated heart failure patients have variable clinical outcomes. Some predictors of mortality in acute heart failure as resting heart rate, blood pressure, Pro-BNP level, and others have been identified. This study addresses the question whether copeptin may add value in the one-year prognosis in this category of high-risk patients. Results: To assess the relationship of serum copeptin level with one year mortality, we evaluated serum copeptin at admission and after 72 hours in 106 consecutive patients hospitalized for acute decompensated heart failure between May 2021 and November 2021 in a tertiary care hospital. Twenty-four patients (23.3%) died during the one-year follow-up period. The mortality was significantly higher in patients with advancing age, male sex, smokers, NYHA class IV heart failure, lower ejection fractions, higher heart rate, higher burden of arrhythmic events, lower creatinine clearance, and higher levels of copeptin at baseline and at day 3. Copeptin level at day 1 with cutoff value of ˃25.4 pmol/l predicted mortality with sensitivity 87.5% and specificity 70.73% [hazard ratio (95% confidence interval): (0.725 - 0.898), P<0.001], while copeptin level at day 3 with cutoff value ˃ 26.1 pmol/l predicted mortality with sensitivity 100% and specificity 73.17% [hazard ratio (95% confidence interval): (0.876 - 0.981), P<0.001]. Finally, increase in copeptin level from bassline was independently associated with increased mortality. (p˂0.001). Conclusions: Elevated copeptin level at baseline and 72 hours post-admission is suggested to be a strong predictor of one year mortality in patients with acute decompensated heart failure.

Sex Differences in Circulating Biomarkers of Heart Failure.

Evidence is scaling up for sex differences in heart failure; however, clinical relevance of sex-specific differential thresholds for biomarkers is not clearly known. Current ambiguity warrants a further look into the sex-specific studies on cardiac biomarkers and may facilitate understanding of phenotypic presentations, clinical manifestations, and pathophysiologic pathway differences in men and women. Recent studies have confirmed the fact that females have differential threshold for biomarkers, with lower troponin and higher NT proBNP levels. Ambiguity continues to exist in the clinical relevance of ST-2, Galectin 3, and other biomarkers. Novel biomarkers, proteomic biomarkers, and circulating micro RNAs with machine learning are actively being explored. Biomarkers in HFpEF patients with higher female representation are evolving. In recent clinical trials, sex-related difference in biomarkers is not seen despite therapeutic intervention being more effective in females compared to males. Sex-related difference exists in the expression of biomarkers in health and in various disease states of heart failure. However, this differentiation has not effectively translated into the clinical practice in terms of diagnostic studies or prognostication. Active exploration to bridge the knowledge gap and novel technologies can shed more light in this area.

Role of Pro-BNP in predicting outcome in acute heart failure patient presenting to a medical emergency: An observational study from North India.

Acute heart failure (AHF) is a clinical syndrome defined as the new onset or acutely decompensated heart failure (ADHF) leading to signs and symptoms of heart failure (HF). The critical cut-off values for these biomarkers that suggest high mortality are not clearly defined in previous studies. More studies are required to better understand the correlation of Pro- BNP and its association with HF. The primary objective is to study the role of Pro-BNP and critical factors in predicting outcomes in AHF patients presenting to a medical emergency. The data from the patients presented with symptoms of HF in the Department of Medical Emergency at our hospital were recorded and analysed. AHF is a clinical syndrome defined as the new onset or ADHF leading to signs and symptoms of HF, as based on the European Society of Cardiology. The present study highlights the various risk factors of AHF in patients and their association with mortality. In the present study, mortality in patients with very high Pro-BNP levels ≥2000 pg/ml was significantly higher than in patients with moderately elevated Pro-BNP. The patients who survived after 5 days of hospitalization had Pro-BNP levels ≤2000 pg/ml, suggesting that very high Pro-BNP levels ≥2000 pg/ml are associated with fatal outcomes. To conclude, diabetes and sepsis are critical factors for the hospitalization and mortality of patients with AHF in northern India. Very high Pro-BNP levels ≥2000 pg/ml in patients with AHF requiring hospitalization and associated with fatal outcomes.

Vascular structure and stiffness in pediatric Mulibrey nanism using ultra-high frequency ultrasound

Mulibrey nanism (MUL) is a disorder with growth delay and congestive heart failure determining prognosis. We aimed to delineate arterial and venous morphology, and arterial stiffness in a representative pediatric MUL cohort. Twenty-three MUL and 23 individually sex and age-matched healthy controls were prospectively assessed in a cross-sectional study with ultra-high frequency ultrasound (48-70 MHz). Heart failure was present in 7 MUL patients, with severe congestive heart failure in 2. Pericardiectomy had been performed in 6 MUL. Arterial lumen diameters and arterial wall layer thickness (intima-media thickness and adventitia thickness) were smaller in MUL patients, but appropriate for body size when compared with controls. Systolic and diastolic blood pressure, aortic and carotid compliance, stiffness as well as central aortic pulsed wave velocity were all similar in MUL compared with controls. Plasma pro-BNP levels were variably elevated (>300 ng/L) in 9/23 MUL patients and in 4/18 MUL patients older than 5 years of age. Internal jugular vein (mean difference 0.054 mm, CI95% 0.024-0.084) and cubital vein (0.046 mm, CI95% 0.013 - 0.078) total wall thickness was elevated in MUL compared with controls. There were no statistically significant relations between vascular parameters and clinical or laboratory signs of heart failure or pericardiectomy. Arterial lumen, wall layer thickness and stiffness are appropriate for body size in MUL, and like healthy controls. Mild venous wall thickening in the upper body region may be due to increased venous pressures related to remodelling caused by diastolic heart failure.

Evaluation of cardiac diagnostic tests findings based on pro-BNP levels in COVID-19 pregnant patients.

Pro-b-type natriuretic peptide (Pro-BNP) is an inflammatory marker that indicates cardiac damage and inflammation. The elevation of this marker in COVID-19 patients can be used as a predictive factor in the prognosis of these patients. Our cross-sectional study investigated the evaluation of cardiac diagnostic test findings based on pro-BNP levels in pregnant COVID-19 patients in Sayyad Shirazi Hospital, Gorgan, Iran, in 2020-2022. A hundred and ten pregnant patients diagnosed with COVID-19 infection were evaluated for cardiac diagnostic tests (electrocardiogram (ECG) and echocardiography (Echo)) and pro-BNP levels. Data were analyzed using SPSS 25 software. Chi-square and Student's t-test will be used to test and compare the relationship between variables and compare them. A P-value less than 0.05 is considered statistically significant. The chi-square test was used to compare the ratio of qualitative variables among the groups if the presuppositions of chi-square distribution were established. Otherwise, Fisher's exact test was used. The mean age of participants were 31.06 ± 5.533 years and 49.1% of patients had pro-BNP levels above the cut-off value for predicting an adverse outcome of COVID-19. The mean ± standard deviation of pro-BNP levels in the low group was 46.125 ± 17.523 pg/mL and in the high group was 878.814 ± 1038.060 pg/mL. This study revealed that patients with higher pro-BNP plasma levels had a significant relation between, myocardial infarction (MI), pericardial effusion (PE), urgent Caesarean section (C/S), and mortality. In addition, no significant relation between gravid, trimester, vaccination, arrhythmia, heart block, and valves diseases with high pro-BNP levels was found. The current research showed that pro-BNP levels can be used as a diagnostic and valuable prognostic tool in pregnant women to diagnose cardiac complications by using ECG and Echo.

The effect of sodium-glucose co-transporter-2 inhibitors following anterior ST-segment elevation myocardial infarction

Abstract Background Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been clearly demonstrated to be associated with lower rate of new-onset heart failure(HF) in patients under risk of HF. In addition, due to lower rehospitalisation and better functional status in HF patients, SGLT-2 inhibitors have became the cornerstone of treatment regardless of the diabetes status. New-onset HF is very common in survivors of anterior ST-segment elevation myocardial infarction(STEMI) and requires preventive strategies, however the role of SGLT-2 inhibition in this population is not well established yet. Purpose In this study, we aimed to demonstrate the role of the SGLT-2 inhibitors in patients with anterior STEMI. Methods We prospectively enrolled patients with diabetes mellitus who had anterior STEMI, which was managed with primary percutaneous coronary intervention. Patients with previous myocardial infarction, heart failure, under SGLT-2 inhibitor treatment and chronic kidney disease were excluded. Patients were divided into two groups according to SGLT-2 inhibitor treatment; group 1 patients treated with empaglifosine or dapaglifosine and group 2 received other classes of diabetes medicine. Comorbidities regarding smoking history (p: 0.871), hypertension (p: 0.064), previous cerebrovascular accident(p: 0,348) and coronary artery disease(p: 0.201) were comparable between groups. Presence of multivessel coronary artery disease (p: 0.259) and left main coronary artery involvement (p: 0.062) were also similar between groups. Glucose level on admission was similar (p: 0.782) between groups, however HBa1C level was significantly higher in group 1(p: <0.001). Left ventricular ejection fraction which was calculated prior to hospital discharge was also similar between groups(p: 0.297). Mean follow-up duration was 12 months and new-onset heart failure was significantly lower in group 1 patients(p:<0.001). In line with the rate of new onset-heart failure, pro-BNP levels at the 12th month visit were lower in group 1 patients (p: 0.042) which was similar during the STEMI hospitalization (p: 0.668). Multivariate analyses demonstrated that the use of SGLT-2 inhibitors independently associated with lower rate of new-onset HF. Conclusion Our results indicate that SGLT-2 inhibitors decrease the rate of new-onset heart failure during the follow-up in patients with previous myocardial infarction.Baseline characteristicsUnivariate and multivariate analysis

Worsening renal function in patients admitted with congestive heart failure: prevalence, risk profile, and hospital readmissions

Abstract Introduction Renal function is often negatively impacted in patients with Congestive Heart Failure (CHF) due to the interplay between the heart and kidneys. Worsening Renal Function (WRF) has been associated with decreased survival, accelerated CHF progression, and higher hospitalization rate. Previous literature has thoroughly documented the effects of CHF on hospital readmissions; however, few studies have examined the impact of WRF on CHF during hospitalization, particularly not in a vulnerable population. Thus, the aim of this study was to determine the prevalence, clinical predictors, and short-term hospital readmissions of WRF among hospitalized CHF patients. Methods This was a retrospective chart review utilizing the data of 297 patients hospitalized for CHF from 2019 to 2020, either due to an exacerbation of symptoms or new-onset of disease. The analysis of our study centered around identifying the risk factors and 30-day hospital readmission rates of patients with WRF, defined as an increase in serum creatinine of ≥ 0.3 mg/dL from admission, in comparison to patients who did not develop WRF. The significance between the two groups was measured using Fisher's Exact test, Wilcoxon rank-sum, and chi-square analysis. A risk score calculated from the sum of point values assigned to each independent risk factor was created. Results Data shows that 27% of hospitalized CHF patients developed WRF. Patients with WRF had a significantly longer hospital stay and a significantly higher increase in daily Creatinine values. We identified old age, overweight, type 2 diabetes (T2D), chronic kidney disease not on dialysis, and high Furosemide dose (oral and intravenous) as independent risk factors. Other independent risk factors include abnormally high serum levels of ProBNP (≥ 9,000 ng/dL), troponin T ≥ (0.04 ng/mm), and Creatinine (≥ 1.5 mg/dL). Based on this data, a point score reflected that patients with a 6+ risk score were four times more likely to develop WRF than patients with a risk score of 0. There was no association between WRF and higher 30-day readmissions. Conclusions WRF is common in hospitalized CHF patients. Although WRF was not associated with an increased 30-day hospital readmission rate, it was associated with longer hospital length of stay and thus increased economic burden. These results highlight the benefits of implementing in-care changes to address the particular risk factors associated with WRF to prevent further progression of renal impairment in hospitalized HF patients. Future directions will incorporate other outcome variables that discern the long-term implications of WRF, including 5-year readmission rates, ESKD, and mortality.

Evaluating the safety and long-term efficacy of triple vasodilator therapy for pulmonary arterial hypertension associated with congenital heart disease

Abstract Background Pulmonary arterial hypertension (PAH) affects 5-10% of congenital heart disease (CHD) patients, but there is limited information on the safety and efficacy of triple combination therapy for PAH-CHD. The aim of this study was to assess the long-term effects of triple therapy (TT) with prostacyclins on PAH-CHD patients. Methods A retrospective, longitudinal, cohort study of patients with PAH-CHD under active follow-up in our center. All patients were receiving baseline dual therapy at maximum doses. Clinical characteristics, including functional class (FC), 6-minute walk test distance (6MWTd), and NT-ProBNP were recorded before initiating TT and during annual follow-ups during 2 years. Results 60 patients were included (median age 41, 31 women 61%). 32 had Eisenmenger syndrome, 9 had coincidental shunts, 18 had postoperative PAH, and 1 had a significant L-R shunt. TT was initiated based on the clinical situation, existence of shunt and ease of administration (epoprostenol 20%, treprostinil 41%, selexipag 32%, iloprost 7%). A significant improvement in the 6MWTd was observed one year after the initiation of TT (p<0.05), which was maintained at two-year follow-up, with an average improvement of 44 metres. An improvement of FC was observed in 79% of patients at one year, maintained at 2 years in 76%. A NT- proBNP levels decreased from the start, and reached significancy two years after the initiation of TT, with an average decrease of 199 ng/l (Figure 1). Twenty patients (33.3%) experienced side effects after drug initiation. Most were mild and well-controlled with symptomatic treatment. Only 3 (5%) had to change the administration route (Figure 2). By subgroups, patients without Eisenmenger and with pre-tricuspid defects had a more marked benefit. Conclusions TT has been shown to be safe and effective in patients with PAH-CHD, improving FC, 6MWTd, and NT-proBNP levels, particularly in pre-tricuspid defects and non-Eisenmenger PAH-CHD.Changes after initiation of TTType of treatment and side-effects

Abstract 13874: N Terminal Pro-Brain Natriuretic Peptide Levels and Benefits of Chronic Total Occlusion Revascularization

Background: The management of chronic total occlusion (CTO) remains a subject of debate, as the mortality benefit from revascularization remains controversial. Whether specific populations gain a survival benefit from CTO revascularization remains unknown. Purpose: In this prospective study of patients with stable coronary artery disease (CAD), we investigated whether patients with CTO have higher adverse event rates and higher N terminal pro-brain natriuretic peptide (NT pro-BNP) levels than patients without CTO. We also investigated whether a higher NT pro-BNP level predicts adverse events in patients with CTO and whether those with elevated NT pro-BNP levels have a survival benefit from revascularization. Methods: In 2,253 patients with significant CAD ( > 50% coronary luminal stenosis) undergoing cardiac catheterization, all-cause mortality, cardiovascular mortality and the composite of cardiovascular death, myocardial infarction and heart failure hospitalization rates were evaluated. Unadjusted and adjusted Cox proportional and Fine and Gray sub-distribution hazard models were performed to determine the association between NT pro-BNP level and event rates. Results: Patients with CTO had higher incident event rates by > 20% and had higher NT pro-BNP levels than those without CTO (median 230.0 vs. 177.7 pg/mL, p=<0.001). In patients with CTO, every doubling of NT pro-BNP level was associated with > 25% greater risk of adverse events. In patients with elevated NT pro-BNP level (> 125 pg/mL), CTO revascularization was associated with >50% lower adverse event rates than those without CTO revascularization (adjusted cardiovascular death hazard ratio 0.24, 95% confidence interval 0.07 - 0.81). Among patients with low NT pro-BNP level (< 125 pg/mL), event rates were similar in those with and without CTO revascularization. Conclusion: Patients with CTO have higher adverse event rates than those with significant CAD without CTO. NT pro-BNP levels are higher in patients with CTO and higher levels portend a worse prognosis. Moreover, NT pro-BNP levels can help identify individuals who may benefit from CTO revascularization.

Abstract 16984: A Wearable Device Reproducibly Identifies Premature Ventricular Contractions and Tachyarrhythmias in Heart Failure Patients

Introduction: occurrence of ventricular arrhythmias (VAs) has a dramatic impact on prognosis of patients with heart failure (HF). Hypothesis: wearable devices, including smartwatch (SW), might provide real-time informations in patients at risk of VAs. Aims: we therefore evaluated if SW detection of QRS interval width and voltage could reproducibly detect VAs and/or premature ventricular contractions (PVCs) in HF patients. Methods: HF patients (N=100) underwent continuous electrocardiographic (ECG) recordings through telemetry and SW during hospital admission. Left ventricular ejection fraction (EF) and laboratory pro-BNP levels assessments were obtained as well. Correlation of the ECG results was addressed using Pearson’s analysis for normally distributed data and Spearman’s analysis for non-parametric data. Bland-Altman was used for reliability between telemetry and SW ECG measurements. Results: mean EF was 45.92±12.12%; mean pro-BNP was 2826±5823 pg/mL. Using the SW and the ECG data, QRS width and voltage correlation coefficients were 0.990 (p<0.001) and 0.974 (p<0.001), respectively. Concordance was found between the two assessments for QRS width (bias, 0.20; SD 3.0; lower limit, –5.68; upper limit, 6.08), and voltage (bias, -0.029; SD, 0.611; lower limit, –1.227; upper limit, 1.169). Moreover, we found correlation coefficients of 0.964 (p<0.001) and 0.970 (p<0.001), respectively, for PVCs width and PVCs voltage using SW and telemetry or other ECG report. Similarly, both techniques showed positive concordance for PVCs width (bias, 0.368; SD, 2.65; lower limit, -4.83; upper limit, 5.56) and PVCs voltage (bias, 0.54; SD, 1.25; lower limit, -1.91; and upper limit, 2.996). Remarkably, VAs identification by the SW was reproducible and standardized. Conclusions: continuous monitoring through SW might be considered in HF patients upon discharge.

Abstract 13569: Impact of Intense Smartphone Application Based versus Routine Outpatient Follow-Up on Short Term Clinical Outcomes in Acute Decompensated Heart Failure (ADHF)

Introduction: Heart failure (HF) poses a global health burden, with about 26 million people affected and an estimated health expenditure of US$31 billion worldwide . The outcome of HF patients with reduced ejection fraction (HFrEF) has improved significantly due to the availability of evidence-based therapies. Still, the readmission rates, and subsequent mortality, have remained unchanged in the last two decades. Despite immense positive evidence, < 25% of patients with HFrEF are on the appropriate target doses of medical therapy. Objectives: Impact of intense versus routine outpatient follow-up on clinical outcomes and patient satisfaction in Acute decompensated heart failure (ADHF) patients over a 3-month follow-up.METHODS: This is a prospective open-label randomized study analyzing readmission rates and achieving target doses of GDMT. Results: A total of 226 subjects (Intense smartphone application-based follow-up -112) (routine outpatient follow-up -114) were enrolled in the study. The mean age was 53 and 54 years in intense follow-up and routine follow up, respectively. Both study arms were well-matched and randomized. There was a significant reduction in rehospitalization rate in the intense follow-up arm (28 vs. 57) p - 0.005. Subjects on smartphone application-based follow-up had better drug compliance and a rapid escalation of GDMT to reach target doses. Number of patients on target dose of GDMT at three months Conclusion: Intense smartphone application based follow-up was feasible and safe for ADHF patients. The incidence of 30-day and three months readmissions improved. They also showed improved BP, HR, and NT Pro-BNP levels. Drug dosages were up-titrated periodically in these subsets of patients based on their cardiac function and laboratory parameters. Newer apps should be designed to incorporate artificial intelligence (AI) with features more likely to improve key patient-reported and clinical outcomes.

Abstract 12716: Left Ventricular Hypertrophy Phenotype to Predict Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

Introduction: Left ventricular hypertrophy (LVH) has been shown to be associated with the occurrence of atrial fibrillation (AF). However, due to the heterogeneous nature of LVH, the predictive value of the LVH phenotype for incident AF remains uncertain. Methods: We utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA). In this study, participants who underwent cardiac magnetic resonance imaging examination were included for analysis. LVH was defined as LV mass index ≥ 85.3 g/m 2 for females and ≥ 107.8 g/m 2 for males. Isolated LVH was determined as LVH without elevated cardiac biomarkers, and malignant LVH was determined as LVH with elevated hs-TnT level of ≥14 ng/L, or/and NT Pro-BNP level of ≥125 pg/mL. Results: A total of 4983 participants were included in the final analysis, with a mean age of 61.5 years. 272 (5.6%) had isolated LVH, and 222 (4.5%) had malignant LVH. During a median follow-up of 8.5 years, 272 cases of AF were observed. Compared to participants without LVH or elevated cardiac biomarkers, those with isolated LVH (HR, 1.82; 95% CI, 1.03-3.20) and malignant LVH (HR, 4.13; 95% CI, 2.77-6.16) had higher AF risks after adjusted for age, sex, race, body mass index, systolic blood pressure, antihypertensive medication use, smoking status, and diabetes. Malignant LVH carried a 1.5-fold increased risk (HR: 2.48, 95% CI: 1.30-4.73) of AF compared to isolated LVH (Panel A). Kaplan-Meier cumulative AF incidence curves showed that malignant LVH had a significantly higher incidence of AF than those in other phenotypes (Panel B). Including the LVH phenotype in the CHARGE-AF model improved model discrimination (areas under the curves[AUC] increase: 0.03, p<0.001) (Panel C). Conclusions: The risks of AF incidence varied across LVH phenotypes, showing that malignant LVH carried a higher risk compared to other LVH phenotypes. LVH phenotype could provide additional predictive power for AF occurrence above the CHARGE-AF model.

Abstract 16282: Incident Heart Failure With Preserved Ejection Fraction in a Cohort of Patients With Biopsy-Proven Non-Alcoholic Fatty Liver Disease

Introduction: Non-alcoholic fatty liver disease (NAFLD) is associated with heart failure with preserved ejection fraction (HFpEF), independent of shared risk factors. The aim of this study was to determine the prevalence, clinical, and echocardiographic (TTE) features of HFpEF in patients with biopsy-proven NAFLD. Methods: We performed a retrospective single-center cohort study of patients with biopsy-proven NAFLD in the Duke NAFLD Biorepository and Clinical Database. Study entry was at the time of liver biopsy and patients were followed until death or 5/1/2023. Clinical and echocardiographic data were abstracted via manual chart review. HFpEF was defined as: at least one TTE characteristic (left atrial volume index ≥ 29 ml/m 2 , septal wall thickness ≥ 1 cm, or evidence of diastolic dysfunction) and signs or symptoms of heart failure (diagnosis of heart failure on problem list, hospitalization for heart failure, elevated NT pro-BNP level, jugular venous distention, use of loop diuretics, pulmonary or peripheral edema, fatigue, or exertional symptoms). Descriptive statistics were evaluated. Results: A total of 742 patients were included in the study. The mean age of the cohort was 50 +/- 12 years, and 83% were White. 95 (13%) had TTE both prior to study entry and during follow up, while 279 patients (38%) had TTE only during follow up. A total of 185 patients met criteria for HFpEF during follow up. After removing patients with TTE evidence of HFpEF prior to study entry, there were 132 cases of incident HFpEF over a mean follow up of 9.1 years, representing 47% of those with TTE after liver biopsy, and 18% of the overall cohort. Considering only TTE criteria, 142 patients had incident HFpEF. During follow up, 12 patients were hospitalized for heart failure. Conclusions: HFpEF is common in patients with NAFLD and a small percentage of patients do not have a chart diagnosis despite meeting echocardiographic criteria, suggesting that HFpEF may be under-recognized. Screening for HFpEF and/or formal care pathways to address early heart failure will be important to prevent morbidity and mortality in this population.

Cardiopulmonary Test As A Component in the Diagnostic Algorithm for Heart Failure with Preserved Left Ventricular Ejection Fraction in Patients with Atrial Fibrillation

Background: Patients with heart failure with preserved ejection fraction account for more than half of all hospitalizations because of heart failure. On the other hand, atrial fibrillation and heart failure are quite often diagnosed together and one disease influences the development of the other. Timely and accurate diagnosis of heart failure with preserved ejection fraction is the basis for effective treatment of this category of patients. In 2019, the HFA-PEFF algorithm of diagnosis heart failure with preserved ejection fraction (including patients with atrial fibrillation) was proposed. However, the algorithm implies cardiac catheterization in patients at intermediate risk, which involves certain difficulties and cannot be used in routine practice. As an alternative to cardiac catheterization in the diagnosis of heart failure with preserved ejection fraction, we proposed a noninvasive diagnostic method cardiopulmonary test. However, the value of cardiopulmonary test technique has not been conclusively studied, especially in patients with a combination of chronic heart failure and atrial fibrillation. Aim: The aim of the study was to evaluate the role of the cardiopulmonary test in the diagnosis of heart failure with preserved ejection fraction in patients with atrial fibrillation. Methods: 138 patients with atrial fibrillation were included in our study. Using HFA-PEFF algorithm (algorithm for diagnosis of heart failure with preserved left ventricular ejection fraction) all patients were initially divided into 3 groups: low probability of heart failure 23 patients, intermediate probability 96 and high probability 19 patients. The stress-test allowed to precisely assess of patients at intermediate risk and finally form the groups: Group 1 without heart failure, 85 patients (61.6%); Group 2 patients with heart failure and preserved ejection fraction, 53 patients (38.4%). The next diagnostic stage was cardiopulmonary test. Results: During cardiopulmonary test, the anaerobic exercise threshold was 6.8 and 4.85 METs for the first and second groups, respectively (p 0.001), reflecting lower exercise tolerance in the second group of patients. Analysis of variance (ANOVA) demonstrated a statistically significant increase in pro-BNP levels with a decrease in peak VO2 (p 0.001). Also, analysis of variance demonstrated a significant statistical difference with respect to systolic pulmonary artery pressure in the subgroups with severely, moderately reduced oxygen consumption and in the group with normal peak VO2 (p=0.01). ROC analysis determined a peak VO2 of 20 ml/kg/min, above which the HFA-PEFF algorithm was unlikely to detect heart failure (AUC 0.73; confidence interval 0.650.82; p=0.043; sensitivity 85%; specificity 51%). Conclusion: The cardiopulmonary test is a reliable instrumental non-invasive method in the diagnosis of heart failure with preserved ejection fraction.

The effects of prophylactic intravenous injection of rhBNP on prognosis in patients with STEMI undergoing PPCI.

This experiment was carried out to observe the application value of recombinant human brain natriuretic peptide (rhBNP) in patients with ST-segment elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI), to provide reference for the future treatment of STEMI. In this study, we selected STEMI patients who underwent PPCI treatment in our hospital from October 2019 to December 2021 were selected as the study subjects, of which 46 received intravenous injections of rhBNP (research group), and 36 STEMI patients underwent PPCI (control group). There was no difference in clinical efficacy between the two groups (P>0.05). After treatment, high-sensitivity cardiac troponin I (hs-cTnI), creatine kinase-MB (CK-MB) and plasma N-terminal pro-BNP (NT-proBNP) levels decreased in both groups, with the research group lower than the control group; cardiac output (CO), cardiac index (CI) and mean arterial pressure (MAP) of the research group were lower than the control group's (P<0.05). The left ventricular ejection fraction (LVEF) in the research group was higher than that in the control group at 1 week and 1 month after treatment, while left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were lower than those in the control group (P<0.05). There was also no difference in the rate of prognostic risk events between the two groups at 6 months of follow-up (P>0.05). Combining the results of these experiments above, we believe that the intravenous injection of rhBNP in STEMI patients undergoing PPCI treatment can improve cardiac function and promote the recovery of hemodynamics.

Evaluation of troponin T levels and cardiac findings of the children in pediatric intensive care with high proBNP levels

Objective: Pro-B type brain natriuretic peptide (proBNP) is released from cardiac ventricular myocytes as a result of increased volume and pressure. Troponin T plays a role in the contraction process. Both proteins may be elevated in many cardiac and non-cardiac conditions. Our aim is to evaluate troponin T values and cardiac findings of the patients in pediatric intensive care unit (PICU) with elevated proBNP levels. Method: Patients with high proBNP values who were admitted to the PICU between January 2022 and January 2023 were included in the study. The clinical diagnoses, proBNP, and troponin T values were recorded. Information about the presence of heart disease and the status of systolic functions were obtained from echocardiographic examination reports. Results: One hundred and ten patients were included in the study. Mean age of the patients was 2.48±3.41 years. Among the patients hospitalized in the pediatric intensive care unit, 41% had lower respiratory tract infections, and 20% had heart disease. The mean proBNP values were 11827.06±12652.82 ng/l, and troponin T was 201.41±737.74 ng/l. Ejection fraction (EF) was normal in 75% of the patients. The mean values of proBNP and troponin T in the patients with normal EF were 7284.74±8437.16 ng/l and 49.67±73.15 ng/l while the mean values of proBNP and troponin were 25129±13659.24 ng/l and 645.8±1380.74 ng/l in the patients with decreased EF (p&lt;0.05, for both). ProBNP and troponin T values of the patients with decreased EF accompanied with or without heart disease were higher than those in the group with normal EF without existing heart disease (p&lt;0.0001, for all). It was observed that decreased EF value was more common in cases who have proBNP&gt;16314 ng/l and troponin T &gt;114 ng/l (p=0.0031, p&lt;0.0001, respectively). Conclusion: ProBNP and troponin T values increase in many cardiac and non-cardiac diseases. However, quite high values of the parameters help to distinguish the patients with cardiac systolic dysfunction.

Cardiac biomarkers comparison between acute myocarditis/myopericarditis and multisystem inflammatory syndrome in children

Objectives: Acute myocarditis/myopericarditis is a heterogeneous disorder of unknown origin, the viral etiology leading the first row. There could be also myocardial involvement in multisystem inflammatory syndrome in children (MIS-C). In this study, we aimed to investigate cardiac biomarkers of acute myocarditis/myopericarditis and MIS-C and to compare these parameters between the two diseases. Methods: Patients who are diagnosed with MIS-C, isolated viral myocarditis/myopericarditis at a university hospital from October 2021 to March 2023 are included in this study. Results: There were 38 MIS-C patients and 53 patients with myocarditis/myopericarditis. The mean age was 141.2 ± 38.2 months (4 to 18 years old) in MISC, and 145.8 ± 52.1 months (7 to 18 years old) in myocarditis/myopericarditis. Median troponin I level was 145 ng/L in MIS-C patients and it was 901 ng/L in myocarditis/myopericarditis patients. Creatinine kinase-myocardial band (CK-MB) median was 2.25 ng/mL (0.6-6.3) versus 6.7 ng/mL in MIS-C and myocarditis/myopericarditis, respectively. Pro Brain natriuretic peptide (Pro-BNP) median level was 2714.5 pg/mL (&amp;lt;300) in MIS-C, and it was 294 in patients with myocarditis/myopericarditis. Troponin I, CK-MB was significantly higher in myocarditis/myopericarditis, while Pro-BNP was significantly higher in MIS-C patients (p &amp;lt; 0.05). The separating power of CK-MB, troponin I, and Pro-BNP level was significantly higher in the differential diagnosis of these two group patients (p &amp;lt; 0.001). MIS-C patients with high pro-BNP levels had more prolonged hospitalization and left ventricular function impairment according to myocarditis/myopericarditis. Conclusions: Cardiac biomarkers (CK-MB, troponin I, and Pro-BNP) could be good markers to estimate the course of the diseases.

PECSS: Pulmonary Embolism Comprehensive Screening Score to safely rule out pulmonary embolism among suspected patients presenting to emergency department

BackgroundPulmonary embolism is a severe cardiovascular disease and can be life-threatening if left untreated. However, the detection rate of pulmonary embolism using existing pretest probability scores remained relatively low and clinical rule out often relied on excessive use of computed tomographic pulmonary angiography.MethodsWe retrospectively collected data from pulmonary embolism suspected patients in Zhongshan Hospital from July 2018 to October 2022. Pulmonary embolism diagnosis and severity grades were confirmed by computed tomographic pulmonary angiography. Patients were randomly divided into derivation and validation set. To construct the Pulmonary Embolism Comprehensive Screening Score (PECSS), we first screened for candidate clinical predictors using univariate logistic regression models. These predictors were then included in a searching algorithm with indicators of Wells score, where a series of points were assigned to each predictor. Optimal D-Dimer cutoff values were investigated and incorporated with PECSS to rule out pulmonary embolism.ResultsIn addition to Wells score, PECSS identified seven clinical predictors (anhelation, abnormal blood pressure, in critical condition when admitted, age > 65 years and high levels of pro-BNP, CRP and UA,) strongly associated with pulmonary embolism. Patients can be safely ruled out of pulmonary embolism if PECSS ≤ 4, or if 4 < PECSS ≤ 6 and D-Dimer ≤ 2.5 mg/L. Comparing with Wells approach, PECSS achieved lower failure rates across all pulmonary embolism severity grades. These findings were validated in the held-out validation set.ConclusionsCompared to Wells score, PECSS approaches achieved lower failure rates and better compromise between sensitivity and specificity. Calculation of PECSS is easy and all predictors are readily available upon emergency department admission, making it widely applicable in clinical settings.Trail registrationThe study was retrospectively registered (No. CJ0647) and approved by Human Genetic Resources in China in April 2022. Ethical approval was received from the Medical Ethics Committee of Zhongshan Hospital (NO.B2021-839R).

Lung ultrasound scan score can identify pulmonary embolism high risk in patients with COVID-19: a retrospective analysis from a single center

Background. Since the European Society of Cardiology (ESC) published guidelines to stratify the risk of pulmonary embolism (PE), the main goal of several physicians has been to find a biomarker able to identify patients with venous thromboembolism at high risk to die. Increased levels of pro-B-type natriuretic peptide (BNP) were suggested as useful biomarkers in the guidelines of ESC (i.e., 2014) to identify patients with PE at high risk of death, but its role was not confirmed in other guidelines. Lung Ultrasound Scan (LUS) has been suggested as a diagnostic and prognostic test to identify patients with a high risk of mortality for lung failure. The aim of this study is to evaluate the prognostic role of pro- BNP together with the LUS evaluation in patients with COVID-19 and PE in particular regarding mortality for pulmonary embolism and overall death. Patients and Methods. We retrospectively analyzed records from 178 patients with confirmed COVID-19, admitted to our ward (i.e., COVID Medicine Unit at Ospedale del Mare in the town of Napoli) between March 2020 and May 2021. For this study, we analyzed the LUS data of all 178 patients and the available data on the pro-BNP of 120 patients. For all selected patients, mortality for PE and overall deaths were recorded. Results. The Propensity Score Matching was used to minimize and erase confounding factors. Data showed that an association between serum levels of pro-BNP and pulmonary thrombotic events was neither present before nor after matching an association with adverse outcomes and was found for increased values of LUS. Discussion. During the first waves of the pandemic, patients with confirmed COVID-19 with severe lung failure frequently showed pulmonary embolism as a clinical acute complication inducing life-threatening evolution. Conclusions. An association between LUS score and severe PE and/or overall mortality in hospitalized patients with COVID-19 was found while a similar association was not confirmed for pro-BNP.

Prognostic Value of Cardiac and Noncardiac Biomarkers in Infective Endocarditis: A Prospective Cross-sectional Study

Background and Aims: Infective endocarditis (IE) is associated with several morbidities and high rate of mortality. Predicting these morbidities can be helpful in managing patients and can prevent possible complications, result from IE. In this study, we aimed to evaluate the association between C-reactive protein (CRP), N-terminal pro brain natriuretic peptide (BNP), monocyte to high density lipoprotein (HDL) ratio Charlson comorbidity index, and European System for Cardiac Operative Risk Evaluation (Euro SCORE) in complicated cases of IE. Materials and Methods: This prospective study was conducted on a referral center from January 2017 to December 2020. Patients with definite or possible diagnosis of IE based on the modified Duke criteria were included in this study. Demographic information and serum levels of N-terminal pro BNP, D-Dimer, CRP were evaluated in patients. In addition, we used Charlson comorbidity index and The Euro SCORE for subjective assessment. Results: One hundred and four patients (64 males, median age: 58) included in the final analysis. Intracardiac involvement, central nervous system (CNS) complications and systemic complications were observed in nine patients (9.7%), 16 patients (15.4%), and eight patients (7.7%) respectively. The mortality rate was 14.4%. D-dimer (P = 0.008), pro-BNP (P = 0.008), and Charlson criteria (P = 0.012) were higher in patients with systematic complications. In addition, NT pro-BNP was significantly associated with CNS complications (P = 0.04) and D-Dimer level was significantly associated with in-hospital mortality (P = 0.008). Conclusion: Serum biomarkers such as pro-BNP and D-dimer, and comorbidity indices can be used for risk stratification of patients with IE. The level of pro-BNP is significantly associated with CNS complications and the level of D-dimer is significantly with mortality in patients with IE.