Pro B-type Natriuretic Peptide Research Articles

Znaczenie stosunku liczby neutrofili do limfocytów jako czynnika predykcyjnego dysfunkcji rozkurczowej lewej komory serca u chorych z przewlekłą chorobą nerek

Introduction. Left ventricular diastolic dysfunction (LVDD) occurs very often in patients with chronic kidney disease (CKD). The neutrophil to lymphocyte ratio (NLR) is a novel inflammatory marker, which has a predictive value in different cardiovascular diseases. We have evaluated the association between NLR and LVDD among CKD patients. Material and methods. The study group consisted of 54 ambulatory patients with CKD at stages 3–5 with preserved left ventricular (LV) systolic function. The CKD patients were divided into two groups, depending on the results of mitral early diastolic velocity EmLV: the group with LV diastolic dysfunction LVDD(+), when EmLV < 8 cm/s, and the group with normal LV diastolic function LVDD(–), when EmLV ≥ 8 cm/s. NLR was calculated as the ratio of the neutrophil and lymphocyte counts. Results. Patients in LVDD(+) group had significantly higher values of NLR when compared to patients in LVDD(–) group (2.51 [1.12–9.82] vs. 1.75 [0.99–3.64], p = 0.007). NLR negatively correlated with EmLV (r = –0.311, p = 0.021), while positively with N-terminal B-type natriuretic propeptide (r = 0.292, p = 0.037). Among the examined parameters, NLR was an independent predictive factor for LVDD with odds ratio 3.14 (95% confidence interval [CI] 1.05–9.42), p = 0.034. The area under the receiver operating characteristics curve for NLR was 0.714 (95% CI 0.575–0.828), p = 0.003, and using a cut point of 1.77, the NLR predicted LVDD with a sensitivity of 92.3% and specificity of 53.6%. Conclusions. This study suggests that elevated neutrophil to lymphocyte ratio as an indicator of inflammation seems to be a useful marker of LVDD in CKD patients.

Comparative study in left heart failure patients with or without pulmonary edema by integrative cardiopulmonary ultrasound

Objective To compare the clinical and echocardiographic parameters in left heart failure patients with or without pulmonary edema by cardiopulmonary ultrasound. Methods All patients underwent transthoracic lung ultrasonography and echocardiography examination. The following echocardiographic parameters were determined: left ventricular end-diastolic and end-systolic diameters (LVEDD and LVESD), left ventricular end-diastolic and end-systolic volumes (LVEDV and LVESV), left ventricular ejection fraction (LVEF), left atrial volume index (LAVindex), systolic pulmonary artery pressure (SPAP) and the degree of mitral regurgitation, the peak Doppler velocities of early (E) and late (A) diastolic flow, early (e′) diastolic velocity of the mitral annulus, and the average E/e′ ratio was calculated. The NYHA functional classification and N-terminal pro B-type natriuretic peptide (NT-proBNP) were also recorded. Results A total of 113 heart failure patients, included 72 patients (63.7%) combined with pulmonary edema revealed by lung ultrasonography. Compared with patients without pulmonary edema, those with pulmonary edema were with higher plasma concentrations of NT-proBNP, NYHA functional class, left ventricular diastolic function classification, SPAP and E/e′, larger LVEDD and the diameter of right ventricle, more severe mitral regurgitation, and lower LVEF(all P<0.05). By multivariate logistic regression analysis, E/e′, SPAP and NT-proBNP were independent echocardiographic predictors of pulmonary edema in patients with heart failure. Conclusions Cardiopulmonary ultrasound can evaluate heart and pulmonary condition in patients with heart failure. Left ventricular diastolic function is an important determinant of pulmonary edema in patients with left heart failure. Key words: Ultrasonography; Heart failure; Pulmonary edema

N-terminal fragment of B-type natriuretic peptide predicts coexisting subclinical heart and vessel disease.

Identification of preclinical cardiovascular disease represents a challenge. We evaluate N-terminal proB-type natriuretic peptides (NT-proBNP) as markers of both cardiac and vascular subclinical disease in a community-based study including asymptomatic middle- aged study participants. In total, 807 study participants without previous cardiovascular disease were recruited. They underwent thorough laboratory assessment (including NT-proBNP), ultrasound examination of heart and evaluation of coronary calcium score and carotid intima-media thickness, by computed tomography and ultrasound, respectively.Cardiac and vascular disease were defined as one among left ventricular (LV) ejection fraction less than 50% (3.1%), E/E' ratio more than 15 (9%), LV mass index more than 115 in men or more than 95 g/m in women (20%), LV end diastolic diameter more than 55 mm (2.5%), coronary calcium score more than 100 AU (13%), or carotid intima-media thickness more than 1.2 mm (21%), respectively. NT-proBNP [OR, 1.275; 95% (confidence interval) CI, 1.007-1.613, P < 0.001], 10-year Framingham risk score (FRS; OR 1.132; 95% CI, 1.058-1.212, P < 0.001) and lower creatinine clearance (OR, 0.983; 95% CI, 0.971-0.994, P < 0.001) predicted cardiac (220, 27%), whereas 10-year Framingham risk score (OR, 1.340; 95% CI, 1.245-1.674, P < 0.001) and NT-proBNP (OR, 1.501; 95% CI, 1.181-1.907, P < 0.001) predicted vascular involvement (215, 26%), at multivariate analysis. In total, 84 study participants (10.1%) had coexisting cardiac and vascular disease. NT-proBNP increased linearly from health study participants to study participants with only cardiac or vascular involvement, up to coexisting cardiovascular disease. Coexisting cardiac and vascular involvement in asymptomatic study participants is common. Along with traditional risk factors, NT-proBNP appears a valuable biomarker for global subclinical heart and vessels disease.

ProBNP strongly predicts future vascular events in peripheral arterial disease patients with as well as in those without the metabolic syndrome

Aim: Pro B-type natriuretic peptide (proBNP) is an established prognostic biomarker in patients with heart failure. Its power to predict cardiovascular endpoints in peripheral arterial disease (PAD) patients with the metabolic syndrome (MetS) is unclear and is addressed in the present study.

319 - Improvements in Cardiac Biomarkers are Associated with Better Health-Related Quality of Life in Patients with Light Chain Amyloidosis

Introduction: Light chain (AL) amyloidosis is a rare, complex disease associated with significant morbidity and mortality. B-type natriuretic peptide (BNP) or N-terminal proB-type natriuretic peptide (NT-proBNP) is used to monitor disease progression and response to treatment among patients with cardiac involvement from AL amyloidosis. The relationships between these cardiac biomarkers and health-related quality of life (HRQoL) are poorly understood in this condition. Hypothesis: Patterns of HRQoL in patients with cardiac AL amyloidosis will differ significantly by changes in BNP or NT-proBNP. Methods: We obtained cardiac biomarker and HRQoL data from patients with AL amyloidosis from two data sources. A subsample of patients with cardiac involvement was drawn from a community-based study of AL amyloidosis patients (n = 108). HRQoL scores (based on the SF-36® Health Survey [SF-36] and the Kansas City Cardiomyopathy Short Form [KCCQ-12]) were examined by patients with and without a history of ≥30% decrease in NT-proBNP. Bivariate analyses were conducted using analysis of variance. HRQoL scores were reported relative to existing benchmarks, including: 1) mean SF-36 scores from both a general population sample and patients with congestive heart failure (CHF); and 2) mean KCCQ scores according to New York Heart Association (NYHA) functional classes. Analysis of variance was used to compare SF-36 scores to age- and sex- adjusted benchmarks. Data were obtained from a subsample of patients with AL amyloidosis seen at the Amyloidosis Center at Boston University between 1994 and 2014 who had pre- and post- assessments (n = 95). Associations between changes in HRQoL and changes in BNP were assessed longitudinally with generalized linear models that controlled for baseline HRQoL scores. Results: In the community-based sample, HRQoL scores differed significantly by NT-proBNP response for all SF-36 and KCCQ scales and summary scores (P < .05 for all) (Fig. 1). Patients without a NT-proBNP response had SF-36 scores that were comparable to CHF benchmarks. Longitudinal analyses based on BNP further supported associations between changes in cardiac biomarkers and changes in HRQoL. Conclusions: Although these cardiac biomarkers have been clinically validated as surrogate treatment measures for survival in AL amyloidosis, these data further support that they may also be useful surrogates for clinical measures such as HRQoL and NYHA status.

The prognostic value of N-terminal proB-type natriuretic peptide in patients with acute respiratory distress syndrome

We investigated whether N-terminal proB-type natriuretic peptide (NT-proBNP) predicts the prognosis of patients with acute respiratory distress syndrome (ARDS). Between December 1, 2012, and May 31, 2015, this observational study recruited patients admitted to our tertiary medical center who met the Berlin criteria for ARDS and who had their NT-proBNP measured. The main outcome was 28-day mortality. We enrolled 61 patients who met the Berlin criteria for ARDS: 7 were classified as mild, 29 as moderate, and 25 as severe. The median APACHE II scores were 23 (interquartile range [IQR], 18–28), and SOFA scores were 11 (IQR, 8–13). The median lung injury score was 3.0 (IQR, 2.50–3.25), and the median level of NT-proBNP was 2011 pg/ml (IQR, 579–7216). Thirty-four patients died during this study, and the 28-day mortality rate was 55.7%. Patients who die were older and had significantly (all p < 0.05) higher APACHE II scores and NT-proBNP levels than did patients who survived. Multivariate analysis identified age (HR: 1.546, 95% CI: 1.174–2.035, p = 0.0019) and NT-proBNP (HR: 1.009, 95% CI: 1.004–1.013, p = 0.0001) as significant risk factors of death. NT-proBNP was associated with poor outcomes for patients with ARDS, and its level predicted mortality.

Association between N-terminal proB-type Natriuretic Peptide and Depressive Symptoms in Patients with Acute Myocardial Infarction.

Background:While depression and certain cardiac biomarkers are associated with acute myocardial infarction (AMI), the relationship between them remains largely unexplored. We examined the association between depressive symptoms and biomarkers in patients with AMI.Methods:We performed a cross-sectional study using data from 103 patients with AMI between March 2013 and September 2014. The levels of depression, N-terminal proB-type natriuretic peptide (NT-proBNP), and troponin I (TnI) were measured at baseline. The patients were divided into two groups: those with depressive symptoms and those without depressive symptoms according to Zung Self-rating Depression Scale (SDS) score. Baseline comparisons between two groups were made using Student's t-test for continuous variables, Chi-square or Fisher's exact test for categorical variables, and Wilcoxon test for variables in skewed distribution. Binomial logistic regression and multivariate linear regression were performed to assess the association between depressive symptoms and biomarkers while adjusting for demographic and clinical variables.Results:Patients with depressive symptoms had significantly higher NT-proBNP levels as compared to patients without depressive symptoms (1135.0 [131.5, 2474.0] vs. 384.0 [133.0, 990.0], Z = −2.470, P = 0.013). Depressive symptoms were associated with higher NT-proBNP levels (odds ratio [OR] = 2.348, 95% CI: 1.344 to 4.103, P = 0.003) and higher body mass index (OR = 1.169, 95% confidence interval [CI]: 1.016 to 1.345, P = 0.029). The total SDS score was associated with the NT-proBNP level (β = 0.327, 95% CI: 1.674 to 6.119, P = 0.001) after multivariable adjustment. In particular, NT-proBNP was associated with three of the depressive dimensions, including core depression (β = 0.299, 95% CI: 0.551 to 2.428, P = 0.002), cognitive depression (β = 0.320, 95% CI: 0.476 to 1.811, P = 0.001), and somatic depression (β = 0.333, 95% CI: 0.240 to 0.847, P = 0.001). Neither the overall depressive symptomatology nor the individual depressive dimensions were associated with TnI levels.Conclusions:Depressive symptoms, especially core depression, cognitive depression, and somatic depression, were related to high NT-proBNP levels in patients with AMI.

Global Longitudinal Strain by Echocardiography Predicts Long-Term Risk of Cardiovascular Morbidity and Mortality in a Low-Risk General Population

Background— Global longitudinal strain (GLS) is prognostic of adverse cardiovascular outcomes in various patient populations, but the prognostic utility of GLS for long-term cardiovascular morbidity and mortality in the general population is unknown. Methods and Results— A total of 1296 participants in a general population study underwent a health examination, including echocardiography measurement of GLS. The primary end point was the composite of incident heart failure, acute myocardial infarction, or cardiovascular death. During a median follow-up of 11 years, 149 (12%) participants were diagnosed with heart failure, acute myocardial infarction, or cardiovascular death. Lower GLS was associated with a higher risk of the composite end point (hazard ratio, 1.12; 95% confidence interval, 1.08–1.17; P &lt;0.001 per 1% decrease), an association that persisted after multivariable adjustment for age, sex, heart rate, hypertension, systolic blood pressure, left ventricular ejection fraction, left ventricular mass index, left ventricular dimension, deceleration time, left atrium dimension, E / e ′, and pro B-type natriuretic peptide (hazard ratio, 1.05; 95% confidence interval, 1.00–1.11; P =0.045 per 1% decrease). GLS provided incremental prognostic information beyond the Framingham Risk Score, the Systemic Coronary Evaluation risk chart, and the modified American College of Cardiology/American Heart Association Pooled Cohort Equation for the composite outcome and incident heart failure. Sex modified the relationship between GLS and outcome such that after multivariable adjustment, GLS was an independent predictor of outcomes in men but not in women (hazard ratio, 1.14; 95% confidence interval, 1.06–1.24; P =0.001, and hazard ratio, 0.99; 95% confidence interval, 0.92–1.07; P =0.81, respectively; P for interaction =0.032). Conclusions— In the general population, GLS provides independent and incremental prognostic information regarding long-term risk of cardiovascular morbidity and mortality. GLS seems to be a stronger prognosticator in men than in women.

Left Atrial Appendage Volume and Plasma Docosahexaenoic Acid Levels Are Associated With Atrial Fibrillation Recurrence After Catheter Ablation.

BackgroundRisk factors for atrial fibrillation (AF) recurrence in patients who have undergone AF catheter ablation have not been fully clarified. The objective of this study was to assess whether the left atrium (LA) and LA appendage (LAA) volumes, and cardio-metabolic markers such as polyunsaturated fatty acids (PUFAs) levels were associated with AF recurrence.MethodsSeventy-seven consecutive patients with AF (mean age, 59 ± 8 years; male, 81%; paroxysmal AF, 64%) undergoing catheter ablation were enrolled. Using contrast-enhanced cardiac multi-detector computed tomography (MDCT) scan, the LA and LAA volume and orifice area were assessed. Radiofrequency ablation was performed by an irrigation catheter, initially targeting the pulmonary veins with a wide area circumferential ablation.ResultsPatients with AF recurrence (36%) exhibited both larger LAA volumes and an LAA orifice area than those without AF recurrence, whereas the LA diameter and LA volumes were not significantly different. Notably, AF recurrence occurred in all patients with a large LAA (≥ 25 mL), and the LAA volume was significantly and negatively associated with docosahexaenoic acid (DHA) levels (β = -0.33, P = 0.003). A multiple regression analysis revealed that the log N-terminal proB-type natriuretic peptide and plasma DHA levels were independent factors for the LAA volume when adjusted for age, AF detected age, left ventricular (LV) ejection fraction, end-systolic LV diameter.ConclusionsThese results suggest that the association between LAA volume and low plasma DHA levels may be an important factor for post-ablation AF recurrence.

Protective effect of Xuebijing injection on myocardial injury in patients with sepsis: a randomized clinical trial

OBJECTIVETo investigate the protective effect and possible mechanism of Xuebijing Injection on myocardial injury in patients with sepsis, and to evaluate its prognostic implications. METHODSPatients with septic myocardial injury were recruited, and were randomly divided into two groups: treatment group and control group. All patients in two groups received conventional cluster treatment, the patients in treatment group additional received Xuebijing injection dissolved in 0.9% sodium chloride injection, and the patients in control group received the same amount of 0.9% sodium chloride injection. At the beginning of treatment and 3, 7 and 10-day after treatment, laboratory indicators of cardiac troponin I (cTnI), N-terminal proB-type natriuretic peptide (NT-proBNP) and procalcitonin (PCT) were respectively tested in venous blood. The patient's length of stay in Intensive Care Unit (ICU) and the mortality in 28 days were recorded. RESULTSAt 3, 7 and 10-day after treatment, the improvements of cTnI, NT-proBNP and PCT in treatment group were better than those in control group, and the differences were statistically significant (P < 0.05). The mortality of treatment group in 28 days was not significantly different from that of control group (P > 0.05). The ICU length of stay of treatment group was shorter than that of control group (P > 0.05). CONCLUSIONXuebijing injection could improve the levels of cTnI, NT-proBNP and PCT in patients with septic myocardial injury. and it had a protective effect on myocardial injury.

Prognostic value of transthoracic echocardiography and biomarkers of cardiac dysfunction in community-acquired pneumonia

The aim of this study was to determine the prognostic role of echocardiography and compare with admission N-terminal proB-type natriuretic peptide (NT-proBNP) levels in adult patients with community-acquired pneumonia (CAP). Consecutive adult patients hospitalized with CAP were prospectively enrolled and followed-up until hospital discharge or death. Echocardiography was performed within the first 48 hours. Complicated hospitalization (CH) was defined as intensive care unit admission, need for mechanical ventilation or in-hospital mortality. This study was registered with ClinicalTrials.gov, number NCT02441855. A total of 15 CH (13.5%) occurred among 111 patients with CAP. CAP patients with a CH compared with those without CH had significantly higher NT-proBNP values (1267.4±1146.1 vs. 305.6±545.7 pg/mL, p <0.001) and troponin I (23.8±24.3 vs. 10.3±6.3 ng/mL, p 0.02) but had lower left ventricle ejection fraction (52.7±8.7 vs. 60.5±6.7%, p <0.001) and tricuspid annular plane systolic excursion (TAPSE), which is a measure of right ventricular systolic function (17.1±4.4 vs. 21.8±4 mm; p 0.001). Patients with elevation of NT-proBNP and decreased TAPSE at presentation had a significantly higher probability of CH (60%) than patients with either elevated NT-proBNP or decreased TAPSE (40%). Patients with neither elevated NT-proBNP nor decreased TAPSE had a 0% probability of CH. This is the first study to demonstrate that decreased right ventricular systolic function is associated with increased rates of adverse events in patients with CAP.

Temporal changes in biomarkers and their relationships to reperfusion and to clinical outcomes among patients with ST segment elevation myocardial infarction.

Coronary plaque rupture mediating acute ST segment elevation myocardial infarction (STEMI) is associated with a systemic inflammatory response. Whether early temporal changes in inflammatory biomarkers are associated with angiographic and electrocardiographic markers of reperfusion and subsequent clinical outcomes is unclear. In the APEX-AMI biomarker substudy, 376 patients with STEMI had inflammatory biomarkers measured at the time of hospital presentation and 24h later. The primary outcome was the 90-day composite of death, shock, or heart failure. Secondary reperfusion outcomes were (1) worst least residual ST segment elevation (ST-E: <1mm, 1 to <2mm, ≥2mm) and (2) post-percutaneous coronary intervention (PCI) TIMI flow grade (0/1/2 vs 3) and TIMI myocardial perfusion grade (TMPG 0/1 vs 2/3). The 90-day incidence of death, shock or heart failure was 21.3% in this cohort. Electrocardiographic reperfusion (worst residual ST-E <1mm, 1 to <2mm, ≥2mm) was associated with differences in 24h change in N-terminal proB-type natriuretic peptide (NT-proBNP) (1192.8, 1332.5, 1859.0ng/mL; p=0.043) and the pro-inflammatory cytokines Interleukin (IL)-6 (14.0, 13.6, 22.1pg/mL; p=0.016), IL-12 (-0.5, -0.9, -0.1pg/mL; p=0.013), and tumor necrosis factor α (TNFα) (1.0, 0.6, 3.6pg/mL; p=0.023). Angiographic reperfusion (TMPG 0/1 vs 2/3) was associated with changes in median NT-proBNP (2649.3, 1382.7ng/mL; p=0.002) and IL-6 (28.7, 15.1; p=0.040). After adjustment for baseline covariates, the 24h change in the pro-inflammatory cytokine TNFα [hazard ratio (HR) 0.49; 95% CI 0.26-0.95; p=0.035] and the anti-inflammatory cytokine IL 10 (HR 1.41; 95% CI 1.06-1.87; p=0.018) were independently associated with the primary composite outcome. Successful coronary reperfusion was associated with less systemic inflammatory response and greater temporal inflammatory changes were independently associated with higher 90-day composite of death, shock, or heart failure. These findings provide support for an association between success of reperfusion, an acute STEMI inflammatory response and subsequent clinical outcomes.

High levels of preoperative and postoperative N terminal B-type natriuretic propeptide influence mortality and cardiovascular complications after noncardiac surgery: A prospective cohort study.

Major noncardiac surgery is associated with a 5% incidence of serious cardiovascular complications and with a 1 to 2% probability of death from cardiac causes. Over the last few decades, researchers have assessed the perioperative predictive power of several risk indices. Research is currently focused on the evaluation of biomarkers. The objective was to determine the incidence of high serum levels of N terminal B-type natriuretic propeptide (NT-proBNP) before and after surgery in adults undergoing elective major noncardiac procedures and to evaluate its relationship with mortality and cardiovascular complications occurring up to 30 days after surgery. Prospective cohort study. Enrolment was undertaken at a university hospital from October 2011 to July 2013. A total of 304 adults with cardiovascular risk factors who underwent noncardiac elective surgery. The relationship between preoperative and postoperative NT-proBNP serum levels and the emergence of cardiovascular complications, including all-cause mortality, during the first 30 days after surgery. The incidence of cardiovascular complications was 7.8% (n = 25), and the mortality rate was 4.3% (n = 13). Higher-than-normal NT-proBNP serum levels were found before surgery in 48.4% (n = 147) and after surgery in 50.7% (n = 154) of patients. The variables found to be independent predictors of cardiovascular complications, including all-cause 30-day mortality, were levels of NT-proBNP more than 300 pg ml before surgery and levels more than 1000 pg ml both before and after surgery. High levels of preoperative and postoperative NT-proBNP are predictors of cardiovascular complications, including all-cause mortality, during the first 30 days after noncardiac surgery in adults with cardiovascular risk factors.

Cardiovascular Mortality in Chest Pain Patients: Comparison of Natriuretic Peptides With Novel Biomarkers of Cardiovascular Stress

BackgroundNatriuretic peptides are the standard biomarker for risk stratification in cardiovascular disease. Novel biomarkers of cardiovascular stress might allow refinement in risk stratification for patients with acute coronary syndrome (ACS). We tested the performance of these novel biomarkers for cardiovascular risk stratification in patients who presented with ACS. MethodsIn the AtheroGene study, 873 patients presented with ACS in the emergency department. Biomarkers measured were: B-type natriuretic peptide (BNP), N-terminal pro BNP (NT-proBNP), midregional proatrial natriuretic peptide, midregional proadrenomedullin (MR-proADM), copeptin, and troponin I. The median follow-up time was 4 years and during this time 50 patients died from cardiac causes. ResultsCox regression analysis for the continuous variables NT-proBNP and BNP showed a hazard ratio (HR) of 1.9 and 1.8, respectively, for 1 SD increase (P < 0.001 and P = 0.003) in the fully adjusted model. Novel biomarkers with MR-proADM had an HR of 3.2, followed by midregional proatrial natriuretic peptide with an HR of 1.9 (both P < 0.001), and copeptin with an HR of 1.6 (P < 0.001). C-index revealed MR-proADM as the best discriminator for identifying patients with the outcome with a C-index = 0.8, and C-index was 0.72 for NT-proBNP (P for comparison = 0.017). Integrated discrimination improvement for MR-proADM was 0.059 compared with NT-proBNP (P = 0.016), thus providing background that MR-proADM was better to identify persons with the outcome. Troponin I levels at the time of admission were not significant for risk stratification. ConclusionsIn patients who present with ACS the novel biomarker, MR-proADM was the best predictor for outcome. MR-proADM adds modest information and is useful for risk prediction in ACS patients.

Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis.

Acute heart failure (AHF) is one of the most common diagnoses assigned to emergency department (ED) patients who are hospitalized. Despite its high prevalence in the emergency setting, the diagnosis of AHF in ED patients with undifferentiated dyspnea can be challenging. The primary objective of this study was to perform a systematic review and meta-analysis of the operating characteristics of diagnostic elements available to the emergency physician for diagnosing AHF. Secondary objectives were to develop a test-treatment threshold model and to calculate interval likelihood ratios (LRs) for natriuretic peptides (NPs) by pooling patient-level results. PubMed, EMBASE, and selected bibliographies were searched from January 1965 to March 2015 using MeSH terms to address the ability of the following index tests to predict AHF as a cause of dyspnea in adult patients in the ED: history and physical examination, electrocardiogram, chest radiograph (CXR), B-type natriuretic peptide (BNP), N-terminal proB-type natriuretic peptide (NT-proBNP), lung ultrasound (US), bedside echocardiography, and bioimpedance. A diagnosis of AHF based on clinical data combined with objective test results served as the criterion standard diagnosis. Data were analyzed using Meta-DiSc software. Authors of all NP studies were contacted to obtain patient-level data. The Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2) for systematic reviews was utilized to evaluate the quality and applicability of the studies included. Based on the included studies, the prevalence of AHF ranged from 29% to 79%. Index tests with pooled positive LRs ≥ 4 were the auscultation of S3 on physical examination (4.0, 95% confidence interval [CI] = 2.7 to 5.9), pulmonary edema on both CXR (4.8, 95% CI = 3.6 to 6.4) and lung US (7.4, 95% CI = 4.2 to 12.8), and reduced ejection fraction observed on bedside echocardiogram (4.1, 95% CI = 2.4 to 7.2). Tests with low negative LRs were BNP < 100 pg/mL (0.11, 95% CI = 0.07 to 0.16), NT-proBNP < 300 pg/mL (0.09, 95% CI = 0.03 to 0.34), and B-line pattern on lung US LR (0.16, 95% CI = 0.05 to 0.51). Interval LRs of BNP concentrations at the low end of "positive" results as defined by a cutoff of 100 pg/mL were substantially lower (100 to 200 pg/mL; 0.29, 95% CI = 0.23 to 0.38) than those associated with higher BNP concentrations (1000 to 1500 pg/mL; 7.12, 95% CI = 4.53 to 11.18). The interval LR of NT-proBNP concentrations even at very high values (30,000 to 200,000 pg/mL) was 3.30 (95% CI = 2.05 to 5.31). Bedside lung US and echocardiography appear to the most useful tests for affirming the presence of AHF while NPs are valuable in excluding the diagnosis.

Comparison of Plasma Atrial Natriuretic Peptide and N-Terminal ProB-Type Natriuretic Peptide Concentrations between Cardiac and Respiratory Diseases in 65 Dogs

Comparison of Plasma Atrial Natriuretic Peptide and N-Terminal ProB-Type Natriuretic Peptide Concentrations between Cardiac and Respiratory Diseases in 65 Dogs

Depressed Corin Levels Indicate Early Systolic Dysfunction Before Increases of Atrial Natriuretic Peptide/B-Type Natriuretic Peptide and Heart Failure Development

Dilated cardiomyopathy is a major cause of heart failure (HF) that affects millions. Corin cleaves and biologically activates pro-atrial natriuretic peptide (pro-ANP) and pro-B-type natriuretic peptide (pro-BNP). High corin levels reduce the development of systolic dysfunction and HF in experimental dilated cardiomyopathy. Yet, patients with significant HF unexpectedly show low corin levels with high plasma ANP/BNP levels. Therefore, we examined the relationship between cardiac corin expression, ANP/BNP levels, and the stages of HF. We used a well-established, dilated cardiomyopathy model to evaluate gene and protein expression as mice longitudinally developed Stages A-D HF. Cardiac systolic function (ejection fraction) continuously declined over time (P<0.001). Cardiac corin transcripts were decreased at early Stage B HF and remained low through Stages C and D (P<0.001). Cardiac corin levels were positively correlated with systolic function (r=0.96, P=0.003) and inversely with lung water (r=-0.92, P=0.001). In contrast, cardiac pro-ANP/BNP transcripts increased later (Stages C and D) and plasma levels rose only with terminal HF (Stage D, P<0.001). Immunoreactive plasma ANP and BNP levels were positively associated with plasma cyclic guanosine monophosphate levels (r=0.82, P=0.01 and r=0.8, P=0.02, respectively). In experimental dilated cardiomyopathy, corin levels declined early with progressive systolic dysfunction before the development of HF, whereas significant increases in plasma ANP, BNP, and cyclic guanosine monophosphate levels were found only in later stage (C and D) HF. This dyssynchrony in expression of corin versus ANP/BNP may impair cleavage activation of pro-natriuretic peptides, and thereby promote the transition from earlier to later stage HF.

Znaczna poprawa kliniczna pacjenta leczonego sildenafilem z powodu nadciśnienia płucnego związanego z nadciśnieniem wrotnym

We report a case of the 59-year-old men with portal hypertension and liver cirrhosis, who developed pulmonary arterial hypertension. The first line treatment with sildenafil 20 mg 3 times daily was introduced as part of a Polish National Treatment Program. At a 6-month follow-up we noticed a significant clinical improvement: the patient’s exercise capacity and echocardiographic parameters were substantially better. In addition, the B-type natriuretic propeptide significantly decreased.

Rapid and dynamic changes of N-terminal proB-type natriuretic peptide (NT-proBNP) in a patient during paroxysmal atrial fibrillation (PAF)

N-terminal proB-type natriuretic peptide (NT-proBNP) is known as a marker of heart failure (HF). NT-proBNP is also elevated in a patient with atrial fibrillation (AF). In this case report, serial assays of NT-proBNP were performed in AF attack without HF. We found the positive association between the level of NT-proBNP and duration of AF attack. This case suggested that secretion of NT-proBNP from left atrium might be abundant in the case of paroxysmal AF (PAF) or PAF might lead to increasing left ventricle stress in a time-dependent manner. Moreover, it is suggested that the measurement of NT-proBNP levels considering the elapsed time after the onset of PAF would be useful.<Learning objective: Measurement of NT-proBNP levels during PAF attack may be useful to estimate the duration of PAF attack and degree of left ventricle stress in patients with PAF.>

Cardiovascular biomarkers in patients with cancer and their association with all-cause mortality

ObjectivePatients with cancer may display elevated levels of B-type natriuretic peptide (BNP) and high-sensitive troponin T (hsTnT) without clinical manifestation of cardiac disease. This study aimed to evaluate circulating cardiovascular...