Serum Brain Natriuretic Peptide Levels Research Articles

Inhibition of TLR9-NF-κB-mediated sterile inflammation improves pressure overload-induced right ventricular dysfunction in rats.

Recent accumulating evidence suggests that sterile inflammation plays a crucial role in the progression of various cardiovascular diseases. However, its contribution to right ventricular (RV) dysfunction remains unknown. The aim of this study was to elucidate whether toll-like receptor 9 (TLR9)-NF-κB-mediated sterile inflammation plays a critical role in the pathogenesis of RV dysfunction. We performed main pulmonary artery banding (PAB) in rats to induce RV pressure overload and dysfunction. On Day 14 after PAB, the pressure overload impaired RV function as indicated by increased RV end-diastolic pressure concomitant with macrophage infiltration and fibrosis, as well as maximal activation of NF-κB and TLR9. Short-term administration (days 14-16 after PAB) of a specific TLR9 inhibitor, E6446, or an NF-κB inhibitor, pyrrolidine dithiocarbamate (PDTC) significantly attenuated NF-κB activation. Furthermore, long-term administration of E6446 (treatment: days 14-28) or PDTC (prevention: days -1 to 28; treatment: days 14 to 28) improved RV dysfunction associated with mitigated macrophage infiltration and fibrosis in right ventricle and decreased serum brain natriuretic peptide levels. Inhibition of TLR9-NF-κB pathway-mediated sterile inflammation improved PAB-induced RV dysfunction in rats. This pathway plays a major role in the progression of pressure overload-induced RV dysfunction and is potentially a novel therapeutic target for the disorder.

Prognostic Value of the 6-Min Walk Test After Open-Heart Valve Surgery

This single-center retrospective analysis aimed to evaluate the prognostic relevance of 6-min walk test (6MWT) in patients admitted to an in-hospital cardiovascular rehabilitation program after open-heart valve surgery. One hundred one patients able to perform a 6MWT within the first week of admission (time after surgery: 16 ± 8 d) were included (age 68 ± 11 y; 55% female; median left ventricular ejection fraction 55% [interquartile range: 50-60]; 51% after aortic valve surgery). Study endpoints were cardiovascular death and the combined outcome of cardiovascular death/cardiac hospitalization. Univariate and multivariate analyses were performed to analyze predictive value of the 6MWT. After a median follow-up of 27 mo, cardiovascular mortality was 9.9% while combined endpoint occurrence was 33%. Patients experiencing study endpoints had lower left ventricular ejection fraction, higher N-terminal prohormone of brain natriuretic peptide serum levels, and longer in-hospital stay (all P < .05). The 6MWT distance was a significant predictor of cardiovascular death (hazard ratio [HR] = 0.89, 95% CI: 0.81-0.97, P = .007) and cardiac hospitalizations (HR = 0.95, 95% CI: 0.90-0.99, P = .02). Even after adjusting for the relevant confounding variables of cardiovascular death and cardiac hospitalization, the adjusted HR = 0.88, 95% CI: 0.75-0.98, P = .028 and adjusted HR = 0.95, 95% CI: 0.90-0.99, P = .05, respectively. In patients admitted to an in-hospital cardiovascular rehabilitation program after open-heart valve surgery, 6MWT proved to be an independent prognostic tool, potentially allowing identification of high-risk patients for whom a more intensive and tailored in-hospital cardiovascular rehabilitation program should be designed and implemented in order to avoid unfavorable cardiovascular events.

Effects of L-carnitine on serum levels of brain natriuretic peptide and N-terminal pro-brain natriuretic peptide and cardiac function in children with severe hand-foot-mouth disease

To observe the effects of L-carnitine treatment on serum levels of brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) and cardiac function in children with heart dysfunction and severe hand-foot-mouth disease (HFMD). A total of 120 children with severe HFMD were enrolled and randomly and equally divided into routine treatment group and L-carnitine treatment group. Thirty healthy children served as the control group. HFMD patients were given anti-fever and antiviral treatment as the basic treatment, while the patients in the L-carnitine treatment group were given L-carnitine as an adjuvant treatment to the basic treatment. Treatment outcomes were observed in the two groups. For all the subjects, serum levels of BNP and NT-proBNP and cardiac function parameters including left ventricular ejection fraction (LVEF), fractional shortening (FS), and cardiac index (CI) were measured at different time points before and after treatment. Before treatment, HFMD patients had significantly higher serum levels of BNP and NT-proBNP and heart rate but significantly lower LVEF, FS, and CI compared with the control group (P<0.05). After treatment, the L-carnitine treatment group had a significantly higher response rate than the routine treatment group (P<0.05). After 3 days of treatment, the serum levels of BNP and NT-proBNP, LVEF, FS, and CI were significantly reduced in the L-carnitine group (P<0.05); the L-carnitine group had significantly lower serum levels of BNP and NT-proBNP, LVEF, FS, and CI than the routine treatment group (P<0.05); there were no significant differences in the serum levels of BNP and NT-proBNP, LVEF, FS, or CI between the L-carnitine treatment and control groups (P>0.05). After 5 days of treatment, there were no significant differences in the serum levels of BNP and NT-proBNP, LVEF, FS, or CI between the L-carnitine treatment and routine treatment groups (P>0.05). Heart rate recovery was significantly slower in the routine treatment group than in the L-carnitine treatment group (P<0.05). As an adjuvant therapy for severe HFMD, L-carnitine treatment has satisfactory short-term efficacy in reducing the serum levels of BNP and NT-proBNP and improving cardiac function, thus improving clinical outcomes.

Ventricular wall stress and silent myocardial damage are associated with pulse pressure in the general population.

Pulse pressure (PP) is a risk factor for cardiovascular diseases and is associated with increased afterload and myocardial oxygen demand. Brain natriuretic peptide (BNP) and heart-type fatty acid-binding protein (H-FABP) are known as biomarkers indicating ventricular wall stress and silent myocardial damage. However, the association between PP and ventricular wall stress and silent myocardial damage in the general population is unclear. The authors enrolled 3504 patients who participated in a community-based annual health check. Serum levels of BNP and H-FABP were measured as markers of ventricular wall stress and silent myocardial damage. Patients were divided into four groups according to the quartiles of PP. Patients in the highest PP group showed higher serum BNP and H-FABP levels than that of the other groups. Multivariate logistic analysis showed that high PP was independently associated with ventricular wall stress and silent myocardial damage on the basis of BNP and H-FABP levels. Compared with systolic blood pressure, diastolic blood pressure, and mean blood pressure, PP was superior in predicting ventricular wall stress and silent myocardial damage evaluated according to BNP and H-FABP levels, which was reflected by the receiver operating characteristic analysis. Screening of healthy patients revealed that high PP was related to high BNP and H-FABP levels, suggesting that an asymptomatic general population with high PP may be exposed to ventricular wall stress and myocardial damage and might be susceptible to silent heart failure.

Clinical utility of left ventricular strain, wall stress and serum brain natriuretic peptide levels in chronic hemodialysis patients.

BackgroundLeft ventricular (LV) global longitudinal strain (GLS) reliably assesses LV systolic function. The precise relation between LV wall stress and serum Brain natriuretic peptide (BNP) concentrations in hemodialysis (HD) patients needs to be clarified. BNP levels are raised in patients with end-stage renal disease (ESRD) and could reflect LV impairment among HD patients.Aim of this workThis study sought to evaluate the clinical utility of LV-GLS, wall stress and serum BNP levels in chronic HD patients. The correlations between BNP levels with both LV wall stress and LV-GLS were assessed.Patients and methods30 ESRD patients on regular HD {categorized into 15 patients with LV ejection fraction (EF) ≤ 50% and 15 patients with LV EF > 50%} and 15-age matched healthy subjects were included. LV function and structure were assessed by conventional echocardiography including LV meridional wall stress (LVMWS), LV mass index (LVMI) and 2-dimensional speckle tracking echocardiography for determination of LV-GLS. Serum BNP levels were evaluated after HD session.ResultsThere were significant increase of LVMSW (189.2 ± 81 vs. 72.2 ± 20.6 dynes/cm2 × 1000, P < 0.0001), higher levels of BNP (1238 ± 1085.5 vs. 71 ± 23.4 pg/ml, P < 0.0001) while LV-GLS was significantly reduced (15.1 ± 3.1 vs. 20.8 ± 1.7%, P < 0.0001) in HD patients compared to controls. Higher values of LVMWS (246.9 ± 67.5 vs. 131.5 ± 43.6 dynes/cm2 × 1000, P < 0.0001) and BNP (1925.4 ± 1087 vs. 550.5 ± 496.5 pg/ml, P < 0.0005) with further impairment of LV-GLS (13.8 ± 2.5 vs. 16.4 ± 5.4%, P < 0.05) were found in patients with LV EF ≤ 50% than those with LV EF > 50%. Serum levels of BNP were positively correlated with LVMI (r = 0.896, P < 0.0001) and LVMWS (r = 0.697, P < 0.0001) but negatively correlated with LV-GLS (r = −0.587, P < 0.0001).ConclusionLV-GLS and LVMWS are useful imaging markers for detection of LV dysfunction in HD patients. Serum BNP level is influenced by LV structural abnormalities and suggested to be a crucial hemodynamic biomarker in those patients.

Effect of combination of parenteral edaravone and nimodipine on ischemic cerebral injury following cerebral hemorrhage

Purpose: To study the clinical effects of parenteral edaravone when combined with nimodipine for the treatment of ischemic cerebral injury following cerebral hemorrhage, and its influence on D-dimer, brain natriuretic peptide (BNP) and transcription factor kB (NF-kB) levels. Methods: A total of 102 cases of ischemic cerebral injury after cerebral hemorrhage seen in 215 Hospital of Nuclear Industry in Shanxi, China from January, 2016 to January, 2017 were included in this study. They were randomly divided into two groups, viz, fifty-two cases in control group and fifty cases in observation group. Control group received nimodipine, while the observation group was given edaravone. Before and after treatment, the two groups’ NIHSS scores were compared. Adverse reactions were recorded, and clinical effectiveness was evaluated. Enzyme-linked immunosorbent assay (ELISA) was used to determin thee levels of serum D-dimmer, BNP and NF-kB in the two groups. Results: Before treatment, the two groups’ NIHSS scores did not show significant differences (p > 0.05). However, after treatment, the observation group’s NIHSS score was significantly lower than that of the control group (p 0.05). However, compared with the control group, D-dimmer, BNP and NF-kB levels in the observation group post-treatment decreased significantly (p < 0.05). Conclusion: These results suggest that the combination of parenteral edaravone and nimodipine has relatively high efficiency and safety, mitigates cerebral ischemia and cerebral edema, and controls inflammatory reactions. Thus, its potentials in this regard requires further investigation. Keywords: Edaravone, Nimodipine, Cerebral ischemia, Ischemic cerebral injury

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

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

Targeted ablation of cardiac sympathetic neurons improves ventricular electrical remodelling in a canine model of chronic myocardial infarction.

The purpose of this study was to evaluate the cardiac electrophysiologic effects of targeted ablation of cardiac sympathetic neurons (TACSN) in a canine model of chronic myocardial infarction (MI). Thirty-eight anaesthetized dogs were randomly assigned into the sham-operated, MI, and MI-TACSN groups, respectively. Myocardial infarction-targeted ablation of cardiac sympathetic neuron was induced by injecting cholera toxin B subunit-saporin compound in the left stellate ganglion (LSG). Five weeks after surgery, the cardiac function, heart rate variability (HRV), ventricular electrophysiological parameters, LSG function and neural activity, serum norepinephrine (NE), nerve growth factor (NGF), and brain natriuretic peptide (BNP) levels were measured. Cardiac sympathetic innervation was determined with immunofluorescence staining of growth associated protein-43 (GAP43) and tyrosine hydroxylase (TH). Compared with MI group, TACSN significantly improved HRV, attenuated LSG function and activity, prolonged corrected QT interval, decreased Tpeak-Tend interval, prolonged ventricular effective refractory period (ERP), and action potential duration (APD), decreased the slopes of APD restitution curves, suppressed the APD alternans, increased ventricular fibrillation threshold, and reduced serum NE, NGF, and BNP levels. Moreover, the densities of GAP43 and TH-positive nerve fibres in the infarcted border zone in the MI-TACSN group were lower than those in the MI group. Targeted ablation of cardiac sympathetic neuron attenuates sympathetic remodelling and improves ventricular electrical remodelling in the chronic phase of MI. These data suggest that TACSN may be a novel approach to treating ventricular arrhythmias.

Shenfu Formula reduces cardiomyocyte apoptosis in heart failure rats by regulating microRNAs

Ethnopharmacological relevanceShenfu decoction consists of the water extract from the dried root or rootstalk of Panax ginseng C. A. Mey (Asian ginseng) and the lateral root of Aconitum carmichaeli Debx (Fuzi, Heishunpian in Chinese). Shenfu Formula has been used as a folk Chinese medicine for thousands of years. Recent studies have shown that Shenfu injection can enhance cardiac function and regulate arrhythmia. Aim of the studyShenfu Formula plays an important role in the treatment of heart failure. However, its microRNA-mediated mechanisms are still not fully understood. Thus, we established a heart failure model in rats to investigate the microRNA mechanism of Shenfu Formula in cardiac function and apoptosis. Materials and methodsThe heart failure animal model was established via left-anterior descending coronary artery ligation in rats. Seven days after surgery, Shenfu Formula was given to the heart failure rats, which were selected by echocardiography with an LVEF< 45%. After Shenfu Formula was given intragastrically for 30 days, blood samples were drawn, the heart was excised after echocardiography, and echocardiographic parameters and apoptosis-related proteins were further examined. Fas/Fas-L and Bcl-2/Bax proteins were analyzed by Western blot, and microRNAs were evaluated using Affymetrix GeneChip miRNA arrays. ResultsShenfu Formula increased the left ventricular ejection fraction, improved the hemodynamic index of heart failure rats, and decreased serum brain natriuretic peptide (BNP) levels. Shenfu Formula also decreased the positive rate of myocardial cells as detected by the TUNEL method and significantly suppressed caspase 3 expression. Moreover, we found that Shenfu Formula can regulate the initiative factors Fas/Fas-L in the intrinsic pathway and Bcl-2/Bax in the extrinsic apoptosis pathway to suppress apoptosis in heart failure rats. Finally, Shenfu Formula potentially alters the balance of microRNAs involved in activating and inhibiting apoptosis, ultimately suppressing apoptosis; this leads to changes in the gene expression profiles of microRNAs targets. ConclusionShenfu Granule can effectively improve cardiac function in heart failure rats, and the anti-apoptosis effects of Shenfu Formula are potential mechanisms for inhibiting heart failure.

Maternal left ventricular hypertrophy and diastolic dysfunction and brain natriuretic peptide concentration in early‐ and late‐onset pre‐eclampsia

Pre-eclampsia (PE) is associated with maternal cardiac remodeling and diastolic dysfunction. The aim of this study was to assess and compare maternal left ventricular structure and diastolic function and levels of brain natriuretic peptide (BNP) in women with early-onset (< 34 weeks' gestation) vs those with late-onset (≥ 34 weeks' gestation) PE. This was a prospective, cross-sectional, observational study of 30 women with early-onset PE, 32 with late-onset PE and 23 normotensive controls. Maternal cardiac structure and diastolic function were assessed by echocardiography and plasma levels of BNP were measured by enzyme immunoassay. Early- and late-onset PE were associated with increased left ventricular mass index and relative wall thickness compared with normotensive controls. In women with early-onset PE, the prevalence of concentric hypertrophy (40%) and diastolic dysfunction (23%) was also significantly higher (both P< 0.05) compared with women with late-onset PE (16% for both). Maternal serum BNP levels were significantly higher (P< 0.05) in women with early-onset PE and correlated with relative wall thickness and left ventricular mass index. Early-onset PE is associated with more severe cardiac impairment than is late-onset PE, as evidenced by an increased prevalence of concentric hypertrophy, diastolic dysfunction and higher levels of BNP. These findings suggest that early-onset PE causes greater myocardial damage, increasing the risk of both peripartum and postpartum cardiovascular morbidity. Although these cardiovascular effects are easily identified by echocardiographic parameters and measuring BNP, further studies are needed to assess their clinical utility. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Liver Stiffness Reflecting Right-Sided Filling Pressure Can Predict Adverse Outcomes in Patients With Heart Failure

ObjectivesThis study sought to investigate whether elevated liver stiffness (LS) values at discharge reflect residual liver congestion and are associated with worse outcomes in patients with heart failure (HF). BackgroundTransient elastography is a newly developed, noninvasive method for assessing LS, which can be highly reflective of right-sided filling pressure associated with passive liver congestion in patients with HF. MethodsLS values were determined for 171 hospitalized patients with HF before discharge using a Fibroscan device. ResultsThe median LS value was 5.6 kPa (interquartile range: 4.4 to 8.1 kPa; range 2.4 to 39.7 kPa) and that of right-sided filling pressure, which was estimated based on LS, was 5.7 mm Hg (interquartile range: 4.1 to 8.2 mm Hg; range 0.1 to 18.9 mm Hg). The patients in the highest LS tertile (>6.9 kPa, corresponding to an estimated right-sided filling pressure of >7.1 mm Hg) had advanced New York Heart Association functional class, high prevalence of jugular venous distention and moderate/severe tricuspid regurgitation, large inferior vena cava (IVC) diameter, low hemoglobin and hematocrit levels, high serum direct bilirubin level, and a similar left ventricular ejection fraction compared with the lower tertiles. During follow-up periods (median: 203 days), 8 (5%) deaths and 33 (19%) hospitalizations for HF were observed. The patients in the highest LS group had a significantly higher mortality rate and HF rehospitalization (hazard ratio: 3.57; 95% confidence interval: 1.93 to 6.83; p < 0.001) compared with the other tertiles. Although LS correlated with IVC diameter and serum direct bilirubin and brain natriuretic peptide levels, LS values were predictive of worse outcomes, even after adjustment for these indices. ConclusionsThese data suggest that LS is a useful index for assessing systemic volume status and predicting the severity of HF, and that the presence of liver congestion at discharge is associated with worse outcomes in patients with HF.

Brain Natriuretic Peptide Levels in Acute Inferior Myocardial Infarction.

BackgroundOur objective was to evaluate the relationship between initial serum brain natriuretic peptide (BNP) levels and right ventricular functions in inferior myocardial infarction (MI) with and without right ventricular involvement.MethodsThe study included 61 patients, who presented with acute inferior MI. Twenty-seven patients had right ventricular involvement. Blood samples for BNP were obtained from each patient on admission. Echocardiographic assessments were performed and recorded during the first 12 h. Right ventricular involvement was determined by electrocardiography, conventional and tissue Doppler echocardiography (TDI).ResultsIn inferior MI with right ventricular involvement, tricuspid annulus planimetric systolic excursion (TAPSE) and right ventricular fractional area change were lower, and left ventricular E/E’ ratio was higher. In the group with BNP levels above 400 pg/mL, left ventricular end-diastolic diameter and left ventricular end-systolic diameter were higher, and left ventricular ejection fraction and TAPSE, indicator of right ventricular systolic function, were lower. The elevated BNP levels were negatively correlated with RSm and TAPSE, while they were positively correlated with the E/E’ ratio. The systolic blood pressure and left ventricular end-diastolic diameter during admission were independent predictors of BNP levels.ConclusionsIn acute inferior MI, initially increased BNP levels may be valuable in predicting the right ventricle involvement. Higher rates of hypotension, right ventricular dysfunction and increased left ventricle diameters are observed in patients with BNP levels ≥ 400 pg/mL.

Usefulness of Serum Omentin-1 Levels for the Prediction of Adverse Cardiac Events in Patients with Hypertrophic Cardiomyopathy

Objective: To investigate the association between serum omentin-1 levels and adverse cardiac events in patients with hypertrophic cardiomyopathy (HCM). Subjects and Methods: This prospective, observational study included 87 patients with HCM and 50 age- and sex-matched control subjects. Serum omentin-1 and brain natriuretic peptide (BNP) levels were measured in all subjects, using enzyme-linked immunosorbent assay and electrochemiluminescence, respectively. Patients with HCM were divided into 2 groups according to their omentin levels, i.e., low: ≤291 ng/mL (n = 48) and high: > 291 ng/mL (n = 39). Cardiac mortality, hospitalization due to heart failure, and implantable cardioverter-defibrillator (ICD) implantation were considered adverse cardiac events. Statistical analysis included uni- and multivariant logistic regression, receiver-operating characteristic (ROC) analysis, and the Kaplan-Meier method. Results: Serum omentin-1 levels were significantly lower in the obstructive (253.9 ± 41.3 ng/mL) and nonobstructive (301.9 ± 39.8 ng/mL) HCM groups than in the control group (767.1 ± 56.4 ng/mL), p < 0.001, respectively. The BNP levels were higher in the obstructive and nonobstructive HCM groups than in the control group (269.5 ± 220, 241.0 ± 227, and 24.0 ± 18.9 pg/mL, respectively, p < 0.001). The Kaplan-Meier analysis indicated that patients with low omentin-1 levels showed a significantly higher (48.2%) 2-year cumulative incidence of overall adverse cardiac events than those with high omentin-1 levels (16.2%) (log-rank test, p = 0.001). In the multivariate logistic regression analysis, omentin-1, interventricular septum (IVS) thickness, and male gender were independent predictors of adverse cardiac events in the follow-up. Conclusion: Omentin-1 levels were lower in patients with HCM than in the control group, and this was associated with worse cardiac outcomes.

The impact of non-alcoholic fatty liver disease fibrosis score on cardiac prognosis in patients with chronic heart failure.

Liver abnormalities have a strong impact on clinical outcomes in patients with heart failure (HF), and are known as cardio-hepatic syndrome. The non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) has been developed to identify liver fibrosis in patients with NAFLD. It remains to be determined whether NFS is associated with cardiovascular prognosis in patients with chronic heart failure (CHF). We calculated NFS in 516 patients with CHF admitted to our hospital. The clinical endpoints were deaths due to progressive HF, myocardial infarction, stroke, and sudden cardiac death, and rehospitalization for worsening HF. There were 173 cardiovascular events noted during a median follow-up of 464days. Patients with cardiovascular events showed a higher NFS as compared with those without. We divided the patients into four groups according to quartiles of NFS. The proportion of New York Heart Association functional class III/IV and serum brain natriuretic peptide levels were increased with increasing NFS. Kaplan-Meier analysis revealed that cardiovascular event rate was increased with increasing NFS in patients with CHF. In multivariate Cox proportional hazards analysis, NFS was independently associated with cardiovascular events after adjustment for confounding factors. Elevated NFS was associated with unfavorable outcomes in patients with CHF. Liver fibrosis assessed by NFS may provide valuable prognostic information in patients with CHF.

Reduction of Cardiopulmonary/Renal Complications with Serum BNP-Guided Volume Status Management in Posthepatectomy Patients

BackgroundAfter hepatectomy, over- and under-resuscitations induce cardiopulmonary complications and acute kidney injury, respectively, leading to significant perioperative morbidity and mortality. Unlike serum chemistries or urine output, serum brain natriuretic peptide (BNP) levels have been shown to accurately reflect current intravascular fluid balance without influence from alterations of hormonal axes. Based on these data, this study was designed to measure the impact of a serum BNP-guided hepatobiliary fluid protocol on the incidence of posthepatectomy cardiopulmonary/renal complications. MethodsHepatectomy patients registered in a single-institution American College of Surgeons-National Surgical Quality Improvement Program database between 2011 and 2016 were examined in real time for the development of cardiopulmonary/renal complications and divided into pre- (2011–2013) and postimplementation (2014–2016) of a BNP-guided hepatobiliary fluid protocol groups. In the postimplementation group, maintenance fluids were tapered on a set protocol. Bolus fluids, diuresis, and micro-adjustments in fluid rate were guided by daily BNP values. ResultsFour hundred sixty patients underwent hepatectomy in the study period with 251 patients in the pre- and 209 patients in the postprotocol implementation groups. Cardiopulmonary/renal complication rates were 4.0% in the preprotocol group and reduced to 0.9% after initiation of the BNP-guided hepatobiliary fluid protocol (p = 0.04). ConclusionsDespite low event rates, these data suggest that goal-directed postoperative fluid therapy with the combination of a hepatobiliary fluid protocol and serum BNP-guided volume management is superior to traditional chemistry and bedside volume assessment and can reduce posthepatectomy cardiopulmonary and renal complications.

Zingiberis rhizoma mediated enhancement of the pharmacological effect of aconiti lateralis radix praeparata against acute heart failure and the underlying biological mechanisms

Aconiti Lateralis Radix Praeparata (Fuzi), a type of Chinese materia medica, has been used to treat acute and chronic heart failure (HF) in traditional Chinese medicine and has been proven in numerous animal studies. It is also well-known that Zingiberis Rhizoma (Ganjiang) is ineffective in the treatment of HF, but it can enhance the anti-HF effect of Fuzi. However, the mechanism underlying this compatibility is still not well investigated. To investigate this mechanism, a model of acute heart failure (AHF) in SD rats induced by propafenone hydrochloride was established in this study. After oral treatments of Ganjiang, Fuzi or a combination of the two drugs in rats with AHF, heart function [e.g., heart rate (HR) and the maximal rising and declining rate of left ventricle pressure (±dp/dtmax)] and serum indicators [e.g., brain natriuretic peptide (BNP), lactate dehydrogenase (LDH) and creatine kinase (CK)] were measured, and histopathological analysis of the heart was also performed. The biological mechanisms were further explored by measuring the protein expression level of the mitochondrial respiration chain complex (MRCC1-4) and the mRNA and protein expression levels of mitochondrial Ca2+ uniporter (MCU) and its upstream proteins, mitochondrial Ca2+ uniporter 1 and mitochondrial Ca2+ uniporter 2 (MICU1-2). The expression levels of key enzymes downstream of the tricarboxylic acid cycle, including pyruvate dehydrogenase (PDH), malate dehydrogenase (MDH) and nicotinamide nucleotide transhydrogenase (NNT), were also measured. As a result, Ganjiang enhanced the therapeutic effect of Fuzi on AHF by raising the HR and ±dp/dtmax; decreasing the serum levels of BNP, LDH and CK; and alleviating histological damage of the myocardial tissue when compared to the treatments of Ganjiang or Fuzi alone. In conclusion, there was an enhancing effect of Ganjiang on the anti-AHF function of Fuzi treatment, and the potential mechanism of this effect may be related to the mitochondrial energy metabolism pathway mediated by MCU.

Factors associated with elevated brain natriuretic peptide level in acute ischemic stroke patients with non-valvular atrial fibrillation

Background: Elevated plasma brain natriuretic peptide (BNP) levels are associated with cardioembolic stroke mainly because of atrial fibrillation (AF). In the present study, we evaluated an array of variables, including BNP level, to determine significant predictors of functional outcome in patients who had non-valvular atrial fibrillation (NVAF) after an acute ischemic stroke (AIS). However, the mechanisms of increased serum BNP levels are hitherto unclear.

P28-5 - The Impact of Pulse Pressure on Silent and Ongoing Myocardial Damage in the General Population

Background: Pulse pressure (PP) is associated with increased afterload and myocardial oxygen demand. PP is also associated with poor prognosis in patients with myocardial infarction and heart failure with preserved ejection fraction. Silent myocardial damage is associated with cardiovascular mortality in the general population. The aim of this study was to investigate the relationship between PP and silent myocardial damage in the general population. Methods and Results: The present study included 3505 subjects who participated in health checkup. We measured serum heart-type fatty acid binding protein (H-FABP) and brain natriuretic peptide (BNP) levels as markers of silent myocardial damage. Subjects were divided into four groups according to the quartiles of PP. Subjects with the highest PP group showed higher serum H-FABP and BNP levels. Multivariate logistic analysis showed that the higher PP was independently associated with silent myocardial damage evaluated by H-FABP (odds ratio (OR): 1.12, P < .05) and BNP (OR: 1.10, P < .05). Receiver operating characteristic (ROC) analysis showed that PP performed best in predicting silent myocardial damage evaluated by H-FABP and BNP compared with systolic blood pressure (BP), diastolic BP, and mean BP (c-index regarding H-FABP: 0.61, P < .05; c-index regarding BNP: 0.61, P < .05). Conclusions: High PP was related to higher H-FABP and BNP levels, suggesting that asymptomatic subjects with high PP may be exposed to myocardial damage.

Atorvastatin/trimetazidine combination therapy in patients with chronic cardiac failure

Purpose: To explore the outcomes and safety of atorvastatin/trimetazidine combination therapy in patients with chronic cardiac failure.Methods: A total of 144 patients with chronic cardiac failure were divided into test group (n = 72) and control group (n = 72). In addition to conventional anti-heart failure treatment, all patients in the two groups received atorvastatin, and those in the test group received, in addition, trimetazidine, for 28 days. The clinical outcomes and safety profiles of the two groups were determined and compared.Results: Compared with pre-treatment stage, the left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), left ventricular early diastolic peak velocity (E), as well as E to left ventricular end diastolic peak velocity (A) ratio (E/A ratio) for both groups improved significantly after treatment, while A and serum brain natriuretic peptide (BNP) level decreased significantly (all p &lt; 0.05). Moreover, compared with control group, the increases in LVEF, LVFS, E, and E/A ratio of the test group were greater (42.81 ± 3.04 vs 47.97 ± 4.22 %; 31.01 ± 3.19 vs 36.02 ± 3.31 %; 57.44 ± 5.18 vs 61.93 ± 5.42 cm/s; 1.02 ± 0.06 vs 1.19 ± 0.11, respectively), while the decreases in A and BNP level were greater (both p &lt; 0.05) (57.34 ± 4.70 vs 52.37 ± 3.17 cm/s; 589.73 ± 41.19 vs 498.65 ± 30.89 pg/mL, respectively). Therapeutic outcomes were significantly better in the test group than in control group (p &lt; 0.05). Blood pressure, heart rate and serum levels of alanine transaminase (ALT) and creatinine did not differ significantly between the two groups (p &gt; 0.05), but serum potassium and aspartate amino transferase levels were lower in the test group than in the control group (p &lt; 0.05).Conclusion: Atorvastatin combined with trimetazidine effectively reduces BNP level and improves cardiac function in patients with cardiac failure. The safety profile of the combined therapy is good.Keywords: Atorvastatin, Trimetazidine, Chronic cardiac failure, Combination therapy, Biochemical profile

Effects of multimodal combination dialysis on Klotho protein, FGF-23 and BNP in patients with maintenance hemodialysis

To discuss the effects of multimodal combination dialysis on Klotho protein, fibroblast growth factor-23 (FGF-23) and brain natriuretic peptide (BNP) in patients with maintenance hemodialysis (MHD). A randomized controlled trial (RCT) was conducted. 120 patients who was diagnosed with chronic renal failure (CRF) uremia receiving MHD over 3 months admitted to Blood Purification Centre of Department of Nephrology of the Second People's Hospital of Guiyang from December 2015 to December 2016 were enrolled, who were randomly divided into hemodialysis (HD) group (HD for 8 times a month), HD + hemofiltration (HF) group (HD for 8 times a month + HF once a month), and HD + HF + hemoperfusion (HP) group (HD for 8 times a month + HF for 4 times a month + HP once a month), with 40 patients in each group. Before and after treatment for 6 months and 12 months, blood was taken from venous circuit tube, the serum Klotho protein and FGF-23 levels were determined by enzyme linked immunosorbent assay (ELISA), and the serum BNP level was determined by electrochemiluminescence. 120 patients with MHD were enrolled in the final analysis without withdrawal. There were no significant differences in the levels of Klotho protein, FGF-23, or BNP before enrollment among the three groups (all P > 0.05). Compared with those before enrollment, the levels of serum Klotho protein after enrollment in three groups showed a sustained upward tendency, which were higher in HD + HF + HP group than in HD + HF group and HD group (μg/L: 2.59±0.61, 1.63±0.35, 1.13±0.26 at 6 months, F = 119.374, P = 0.000; 6.98±1.21, 3.57±1.03, 2.12±0.43 at 12 months, F = 275.675, P = 0.000); the levels of FGF-23 showed a sustained downward tendency, which were lower in HD + HF + HP group than in HD + HF group and HD group (ng/L: 69.22±38.26, 132.28±61.18, 178.50±74.64 at 6 months, F = 33.509, P = 0.000; 32.81±17.32, 87.93±43.27, 146.33±69.28 at 12 months, F = 55.466, P = 0.000); the BNP showed a similar tendency as FGF-23 (ng/L: 4 083.39±2 864.53, 7 245.69±4 643.81, 7 969.12±5 360.85 at 6 months, F = 8.758, P = 0.000; 1 521.86±894.63, 4 554.32±1 969.84, 5 013.89±2 033.64 at 12 months, F = 49.003, P = 0.000). Multimodal combination dialysis can increase the Klotho protein level, and decrease the levels of FGF-23 and BNP in MHD patients with CRF uremia.