Serum N-terminal Pro-brain Natriuretic Peptide Levels Research Articles

Role of NT-proBNP and lung ultrasound in diagnosing and classifying heart failure in a hospitalized oldest-old population: a cross-sectional study.

Diagnosing and classifying heart failure (HF) in the oldest-old patients has technical and interpretation issues, especially in the acute setting. We assessed the usefulness of both N-terminal pro-brain natriuretic peptide (NT-proBNP) and lung ultrasound (LUS) for confirming HF diagnosis and predicting, among hospitalized HF patients, those with reduced ejection fraction (HFrEF). We performed a cross-sectional study on 148 consecutive patients aged ≥ 80 years admitted to our Internal Medicine and Geriatrics ward with at least one symptom/sign compatible with HF and NT-proBNP ≥ 125 pg/mL. We measured serum NT-proBNP levels and performed LUS and transthoracic echocardiography (TTE) on admission before diuretic therapy. We divided our cohort into three subgroups according to the left ventricular ejection fraction (LVEF): reduced (LVEF ≤ 40%), mildly-reduced (LVEF = 41-49%) and preserved (LVEF ≥ 50%). The mean age was 88±5 years. Male prevalence was 42%. Patients with HFrEF were 19%. Clinical features and laboratory parameters did not differ between the three subgroups, except for higher NT-proBNP in HFrEF patients, which also had a higher number of total B-lines and intercostal spaces of pleural effusion at LUS. Overall, NT-proBNP showed an inverse correlation with LVEF (r = -0.22, p = 0.007) and a direct correlation with age, total pulmonary B-lines, and intercostal spaces of pleural effusion. According to the ROCs, NT-proBNP levels, pulmonary B-lines and pleural effusion extension were poorly predictive for HFrEF. The best-performing cut-offs were 9531 pg/mL for NT-proBNP (SP 0.70, SE 0.50), 13 for total B-lines (SP 0.69, SE 0.85) and one intercostal space for pleural effusion (SP 0.55, SE 0.89). Patients with admission NT-proBNP ≥ 9531 pg/mL had a 2-fold higher risk for HFrEF (OR 2.5, 95% CI 1.3-4.9), while we did not find any association for total B-lines ≥ 13 or pleural effusion ≥ 1 intercostal space with HFrEF. A significant association with HFrEF emerged for the combination of NT-proBNP ≥ 9531 pg/mL, total B-lines ≥ 13 and intercostal spaces of pleural effusion ≥ 1 (adjusted OR 4.3, 95% CI 1.5-12.9). Although NT-proBNP and LUS help diagnose HF, their accuracy in discriminating HFrEF from non-HFrEF was poor in our real-life clinical study on oldest-old hospitalized patients, making the use of TTE still necessary to distinguish HF phenotypes in this peculiar setting. These data require confirmation in more extensive and longer prospective studies.

Serum biomarkers in patients with psoriasis and coronary artery disease and their impact on hospitalization: data form a prospective, 4-year, single-center, uncontrolled study

Aim. To study serum biomarker profile in patients with coronary artery disease (CAD) and psoriasis and the impact on the incidence of hospitalization for cardiovascular reasons and psoriasis.Material and methods. The study included 90 patients divided into following 3 groups: with psoriasis (n=30), coronary artery disease (CAD) (n=30) and CAD+psoriasis (n=30) in whom serum biomarkers were determined at the beginning of the study (growth stimulation expressed gene 2, N-terminal pro-brain natriuretic peptide (NT-proBNP), interleukin-17 and tumor necrosis factor alpha) and hospitalization rates were monitored over 4 years.Results. There was a significant difference in the concentrations of all biomarkers between the groups (p<0,05), with the maximum values being in the CAD+psoriasis group, except for NT-proBNP. In regression analysis, risk factors for cardiovascular hospitalizations were psoriasis (p=0,049) and increased NT-proBNP concentrations (p<0,001).Conclusion. Comorbidity leads to an increase in the serum concentration of biomarkers, while the risk factors for cardiovascular hospitalization were psoriasis and serum NT-proBNP level.

Association Between Serum NT-proBNP and Gray Matter Atrophy Patterns in an Older Japanese Population: The Hisayama Study.

Several population-based studies have reported that higher serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are associated with brain morphological changes. However, no population-based studies have examined the relationship between serum NT-proBNP and various regional brain volumes in detail. We here analyzed the brain MRI data of 1201 community-dwelling Japanese aged ≥65 years. Regional gray matter volumes (GMV) and intracranial volume (ICV) were estimated by applying voxel-based morphometry (VBM) methods. The associations of serum NT-proBNP with regional GMV/ICV were examined by analysis of covariance. The regional gray matter atrophy patterns associated with elevated serum NT-proBNP levels were investigated using VBM without a priori regions of interest. The multivariable-adjusted means of the frontal, temporal, hippocampal, parahippocampal, and entorhinal GMV/ICV decreased significantly with elevated serum NT-proBNP levels (all p for trend and q values of false discovery rate correction < .05). In VBM, elevated serum NT-proBNP levels were correlated with atrophy of the bilateral hippocampi, bilateral amygdalas, bilateral parahippocampal gyri, bilateral entorhinal areas, bilateral fusiform gyri, left middle temporal gyrus, left inferior temporal gyrus, right central operculum, right posterior orbital gyrus, bilateral middle frontal gyri, anterior cingulate gyrus and bilateral medial frontal cortices. In a sensitivity analysis excluding 254 participants with mild cognitive impairment or dementia, serum NT-proBNP levels were correlated with atrophy of the bilateral hippocampi, bilateral amygdalas, bilateral parahippocampal gyri, bilateral fusiform gyri, and left middle frontal gyrus. Our data suggest that elevated serum NT-proBNP levels are associated with gray matter atrophy in brain regions that play an important role in cognitive function.

N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) as a Marker for Risk Stratification and Prediction of Functional Outcome in Acute Ischaemic Stroke

Introduction: Stroke is the second leading cause of mortality and disability worldwide. A large proportion of stroke survivors are left with significant disability. Assessing stroke severity and predicting morbidity and mortality is essential for treatment decisions and counseling. Traditionally used tools like the National Institutes of Health Stroke Scale (NIHSS) are not reliable in predicting mortality. Studies have shown that B-type Natriuretic Peptide (BNP) and N-terminal pro Brain Natriuretic Peptide (NT-proBNP) are elevated in acute stroke. Aim: To assess the prognostic importance of NT-proBNP in stroke. Materials and Methods: A prospective cohort study was conducted at Sri Devaraj URS Medical College (SDUMC), SDUAHER, Kolar, Karnataka, India involving 64 consecutive stroke patients from July 2018 to September 2019. Serum NTproBNP levels were measured on both the day of admission and on day 7. Stroke severity was assessed using the NIHSS on admission day, and functional disability was determined using the Barthel Index (BI) at the 3-month mark. Data were entered into MS Excel for statistical analysis, where a p-value of &lt;0.05 was considered statistically significant. Results: The average age of the subjects was 62.36 years with a standard deviation of 12.15 years. The average NIHSS on the day of admission was 12.81 (7), and it was 20.2 (5.882) among deceased patients. The mean NT-proBNP on admission was 776.70 (1023.6) pg/mL, significantly elevated in deceased patients at 2014.65 (1320.546) compared to survivors at 328.94 (239.353). NT-proBNP is strongly associated with stroke severity (NIHSS) (R2=0.522; Spearman’s correlation coefficient=0.843, p-value &lt;0.001) and functional outcome (BI) (R2=0.824; Spearman’s correlation coefficient -0.923, p-value &lt;0.001) at three months.On Receiver Operating Characteristic (ROC) analysis, a serum NT-proBNP level of 960 pg/mL had a sensitivity and specificity of 94.1% and 97.9% in predicting mortality, and a value of 435.1 pg/mL had a sensitivity and specificity of 90% and 81% in predicting disability. Conclusion: Serum NT-proBNP was significantly elevated in patients after stroke and was strongly associated with stroke severity and functional outcome at three months. Measuring serum NT-proBNP on the day of admission can predict mortality and functional dependence after acute ischaemic stroke.

Prognostic significance of NT-proBNP and sST2 biomarkers in patients with post-myocardial infarction heart failure after a coronavirus infection

Aim. To determine the prognostic significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) and soluble ST2 (sST2) in patients with post-myocardial infarction heart failure after a coronavirus disease 2019 (COVID-19)Material and methods. Three following groups were formed: in patients of group I (main), who underwent inpatient treatment for COVID-19, the cause of heart failure (HF) was prior Q-wave myocardial infarction; in patients of group II (comparison) without COVID-19, the cause of HF was prior Q-wave myocardial infarction; Group III (comparison) — patients with HF of ischemic origin without postinfarction cardiosclerosis and COVID-19. Statistical processing was carried out using the software package IBM SPSS Statistics Version 26.0.Results. The patients of all three groups included in the present study were comparable. After 6 months in group I, HF course worsening was recorded. In patients of groups I and II, an increase in NYHA HF class from 2 to 3 and 4 was recorded, in contrast to patients of group III, among whom the number of patients with class 3 HF decreased by 25% due to compensation to class 2. Patients of the studied groups, who had elevated serum levels of NT-proBNP and sST2, had more pronounced structural and functional myocardial disorders than patients with normal levels of these biomarkers. Using analysis of adverse cardiovascular events, such as recurrent myocardial infarction, cerebrovascular accident, hospitalization due to coronary artery disease, decompensated HF, which required hospitalization, a predictive model was developed using a neural network. There were following most important factors of the developed model: age, level of NT-proBNP and sST2, lung involvement according to computed tomography.Conclusion. Modern biomarkers NT-proBNP and sST2 have sufficient predictive value to determine the risk of adverse events in HF.

IMPROVEMENT OF PREDICTIVE UTILITY OF NATRIURETIC PEPTIDE FOR HEART FAILURE WITH PRESERVED EJECTION FRACTION WITH APELIN IN TYPE 2 DIABETES MELLITUS PATIENTS

Objective: Apelin plays a pivotal role in adverse cardiac remodeling and the occurrence of heart failure (HF) with reduced ejection fraction in type 2 diabetes mellitus (T2DM). The purpose of the study was to investigate whether serum levels of apelin predict HF with preserved ejection fraction (HFpEF) in patients with T2DM Design and method: The study was retrospectively involved 76 T2DM individuals aged from 41 to 65 years (48 patients with overt HFpEF and 28 non-HFpEF patients). Healthy control group was consisted of 25 individuals matched with age and sex. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), apelin, and high sensitive C-reactive protein (hs-CRP) were determined by ELISA Results: Serum levels of apelin and NT-proBNP were significantly increased in patients with HFpEF (7.74 ng/mL, 95% CI = 6.31-8.25 ng/mL and 954.8 pmol/mL, 95% CI = 476.2-1764.3 pmol/mL, respectively) when compared with non-HFpEF diabetics (2.26 ng/mL; 95% CI = 1.70-2.90 ng/mL; and 113.5 pmol/mL, 95% CI = 75.4-144.9 pmol/mL, respectively) and healthy volunteers (1.52 ng/mL 95% CI = 1.12-2.13 ng/mL and 67.8 pmol/mL, 95% CI = 49.1-87.4 pmol/mL; respectively). Apelin levels correlated positively with body mass index (r = 0.32, P = 0.001), serum uric acid (r = 0.30, P = 0.016), HDL cholesterol (r = 0.28, P = 0.001), hs-CRP (r = 0.26, P = 0.001) and were negatively associated with ejection fraction (r = 0.34, P = 0.002), and age (r = -0.30, P = 0.001). The ROC curve showed that the best fitted cut-off point for the apelin to NT-proBNP ratio was 0.82 units (area under curve = 0.76; sensitivity = 69.5%, and specificity 94.2%, P = 0.001). In multivariate logistic regression analysis the apelin to NT-proBNP ratio &lt; 0.82 × 10-2 units independently predicted (odds ratio = 1.44; 95% confidence interval: 1.18 – 2.77; P = 0.001) HFpEF in T2DM patients. Conclusions: Apelin to NT-proBNP ratio &lt; 0.82 × 10-2 was independent predictor for HFpEF in T2DM patients

Combination of cardiac color Doppler ultrasound, serum MR-ProANP and NT-ProBNP forecasted hypertensive LVH and LFH

ABSTRACT To analyze the value of the combined test of the cardiac color Doppler ultrasound, the serum middle receptor pro-atrial natriuretic peptide (MR-ProANP) and the N-terminal pro-brain natriuretic peptide (NT-ProBNP) in forecasting the hypertensive left ventricular hypertrophy (LVH) and left heart failure (LHF). All patients were subjected to cardiac color Doppler ultrasound examination to obtain left atrium volume index (LAVI), left ventricular end-diastolic diameter (LVEDD), early-diastolic peak flow velocity (E), early-diastolic mean flow velocity (e’), early-diastolic peak flow velocity/early-diastolic mean flow velocity (E/e’) and left ventricular ejection fraction (LVEF). Biomarkers were performed to obtain serum MR-ProANP and NT-ProBNP concentrations, and statistical analysis was performed. The LVEF was obviously lower than that in the control group (P<0.01). The area under the receiver operating characteristic (ROC) curve (AUC) values of LVEF, E/e’, serum MR-ProANP and NT-ProBNP alone were in the range of 0.7–0.8. The AUC, sensitivity and specificity of LVEF and E/e’ combined with MR-ProANP and NT-ProBNP to diagnose hypertensive LVH and LHF were 0.892, 89.14% and 78.21%, which were higher than those of single diagnosis. In the heart failure group, LVEF was negatively correlated with serum MR-ProANP and NT-ProBNP concentrations (P<0.05), and E/e’ was positively correlated with serum MR-ProANP and NT-ProBNP concentrations (P<0.05). Pump function and ventricular remodeling in patients with hypertensive LVH and LHF are closely related to serum MR-ProANP and NT-ProBNP levels. Combination of the two testing can improve the prediction and diagnostic efficacy of LHF.

Oxygenation index and NT-proBNP as predictors of pulmonary hypertension and ventilation/perfusion mismatch in acute pulmonary embolism.

The magnitude of pulmonary artery pressure (PAP) and the extent of ventilation/perfusion (V/Q) mismatch are essential for assessing the prognosis of acute pulmonary embolism (APE). We aimed to develop a model for predicting the status of the pulmonary circulation and arterial gas exchange functions using serum levels of cardiac biomarkers and arterial oxygenation index (OI) values. This single-center, retrospective observational cohort study included 224 patients with APE. Multivariate linear regression and Poisson regression were used to test the statistical association between cardiac biomarkers, OI, PAP, and V/Q mismatch. Diagnostic efficiency was calculated from a receiver operating characteristic (ROC) curve. Serum levels of troponin I (TNI), N-terminal pro-brain natriuretic peptide (NT-proBNP), and arterial OI magnitude significantly correlated with PAP and V/Q mismatches (P < 0.05). Multivariate linear regression showed that NT-proBNP serum levels (β = 0.002, P < 0.001) and OI values (β = -0.022, P = 0.001) significantly influenced PAP. Arterial OI (β = -0.039, P < 0.001) had a significant influence on the percentage of pulmonary vascular obstruction (PVO) as determined by perfusion scanning. Poisson regression showed that OI (odds ratio: 0.995, p < 0.001) was a predictor of the number of lung segments with V/Q mismatches. ROC area under the curve (AUC) values of NT-proBNP and OI predicting pulmonary hypertension were 0.716 and 0.730, respectively, and for V/Q mismatch scanning, the results were 0.601 and 0.634, respectively. Arterial OI and serum levels of cardiac biomarkers may be used as indicators of pulmonary hypertension and V/Q mismatch.

The diagnostic value of n-terminal probrain natriuretic peptides to differentiate neonatal pneumoniae and transient tachypnea of the newborn.

The primary objective of the study was to determine the diagnostic value of serum N-terminal probrain natriuretic peptide (NT-proBNP) levels to differentiate neonatal pneumonia (NP) and transient tachypnea of the newborn (TTN). The secondary objective was to investigate the prognostic role of NT-proBNP levels in neonates with severe respiratory distress (RD). A prospective, observational, single-blinded study involving 58 late preterm and term newborns who were diagnosed with TTN or NP was conducted between June 2020 and June 2021 at a level-3 neonatal intensive care unit in Kırıkkale University Faculty of Medicine. TTN and NP groups were compared for serum NT-proBNP levels measured at the 1st and 24th hours of life. Optimal cut-off NT-proBNP value was determined by Youden index to predict the diagnosis of NP. Lung ultrasound was used to support the diagnosis of TTN and NP. In addition, lung ultrasound score (LUS) was used to determine severe RD. The median of NT-proBNP level was significantly higher at the 24th hour of life in the NP group than in the TTN group, respectively 7263.5 pg/mL (1643-35,000) and 3308 pg/mL (69-19,746), p = 0.004. At a cut-off value of 5515.5 pg/mL, NT-proBNP had a sensitivity of 75% and specificity of 73.8% to predict NP [AUC= 0.749 (95% CI: 0.602-0.895; p = 0.004)]. The study population was divided into two groups as high score group (n: 23, LUS ≥ 7) and low score group (n: 35, LUS < 7) according to the LUS at the 6th hour of life. NT-proBNP values at 24th hour of life were 6320 pg/mL (69-35,000) in high score group and 3500 pg/mL (570-15,948) in low score group, p = 0.044. Duration of oxygen support (p = 0.006), noninvasive ventilation (p = 0.008) and NICU stay (p = 0.004) were higher in high-score group. NT-proBNP values at 24th hour of life can be used as a relatively early predictor in the differentiation between NP and TTN in late preterm and term neonates. In addition, elevated NT-proBNP values are related to the higher LUS which reflects the severity of RD regardless of diagnosis.

Effectiveness of periodontal intervention on the levels of N-terminal pro-brain natriuretic peptide in chronic periodontitis patients.

Background: N-terminal-pro-brain natriuretic peptide (NT-proBNP) is an inactive hormone that is seen during inflammation and is a known biomarker of cardiovascular disease (CVD). Evidence suggests that periodontitis has a bidirectional relationship with CVD and NT-proBNP has a potential role in periodontal disease. However, there is no evidence on the impact of nonsurgical periodontal therapy (NSPT) on the levels of NT-proBNP in gingival crevicular fluid (GCF) and serum in patients with chronic periodontitis. Hence, the aim of this study was to compare the levels of NT-proBNP in GCF and serum in patients with chronic generalized periodontitis. Materials and methods: GCF and serum samples were collected in 19 patients with chronic periodontitis before and after NSPT after 6 weeks and the cumulative or reduction in values of NT-proBNP in GCF and serum was assessed. NT-proBNP levels in GCF and serum were determined by enzyme-linked immunosorbent assay. Results: The concentrations of NT-proBNP were significantly reduced in GCF and serum after NSPT. Statistically significant difference of NT-proBNP concentration between pre- and postgroups in GCF was apparent (p &lt; 0.0001), whereas statistically nonsignificant results in NT-proBNP serum levels when compared at baseline to postoperative state with mean of 61.77 (22.6 standard deviation [SD]) preoperatively and 72.67 (51.86 SD) postoperatively (p = 0.0007) was observed. Conclusion: Significant reduction of NT-proBNP concentrations in GCF and serum in patients with chronic periodontitis subjected to NSPT was observed. This may account for a significant relation between periodontal disease, bacteremia, and CVD.

The correlation between maternal serum sST2, IL‐33 and NT‐proBNP concentrations and occurrence of pre‐eclampsia in twin pregnancies: A longitudinal study

The primary objective of this study was to determine the longitudinal profile of serum sST2 (soluble suppression of tumorigenicity 2), IL-33 (interleukin-33) and NT-proBNP (N-terminal pro-brain natriuretic peptide) concentrations in twin pregnancies with pre-eclampsia (PE) and those normotensive twins. The secondary objective was to test whether the change of serum sST2,IL-33 and NT-proBNP is related to PE in twin pregnancies. This is a longitudinal nested case-control study and all 156 dichorionic (DC) pregnancies were from a prospective cohort of twin pregnancies who received antenatal care and gave two live births at Peking University Third Hospital between October 2017 and September 2020. Four to five milliliters of peripheral blood of each pregnant woman were collected during the following three intervals: (1) 6-11+6 weeks; (2) 24-27+6 weeks; (3) 28-31+6 weeks. We found that sST2 and NT-proBNP levels increased as pregnancy progressed in normotensive twin pregnancies and further increased in PE group, while no differences were found in IL-33 levels throughout pregnancy. Then the correlation of biomarker levels with the occurrence of PE was assessed. Our results indicated that combining maternal serum sST2 and NT-proBNP levels yielded the highest predictive value on the occurrence of PE significantly higher than the predictive value of any markers alone. Interestingly, the predictive value of second trimester (AUC=0.876, 95%CI 0.824-0.928, LR-0.338, LR+7.67, p<0.001)was higher than that of early-third trimester (AUC=0.832, 95%CI 0.769-0.896, LR-0.29, LR+3.845, p<0.001). Serum sST2 and NT-proBNP concentrations during second and early-third trimester were associated with the occurrence of PE in twin pregnancies.

Ultrasound dynamic monitoring of IVCD to guide application of CRRT in patients with renal failure combined with acute heart failure

We explored the application value of bedside ultrasound dynamic monitoring of the inferior vena cava diameter (IVCD) and collapse with sniff (inferior vena cava collapsibility index [IVCCI]) to guide dehydration adjustment in continuous renal replacement therapy (CRRT) in patients with combined renal failure and acute heart failure. We selected 90 patients with combined renal and acute heart failure who required CRRT in the intensive care unit (ICU) from January 2019 to June 2021. According to different blood volume assessment methods, patients were randomly divided into ultrasound, experience, and control groups. We compared serum creatinine, potassium, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels; time to improved heart failure symptoms; CRRT time; ventilator use; ICU length of stay; vasopressor use; and incidence of adverse events among groups. There were no significant differences in serum creatinine, potassium, and NT-proBNP levels in pairwise comparisons among groups before and after CRRT (P > 0.05). The time to improved heart failure symptoms, CRRT time, and ICU length of stay in the ultrasound and experience groups were lower than those in the control group; the differences were statistically significant (P < 0.05). Ventilator use duration was lower in the ultrasound and experience groups compared with the control group, with a statistically significant difference between the ultrasound and control groups (P < 0.05). The duration of vasopressor use in the ultrasound and control groups was lower than that in the experience group; the difference was statistically significant (P < 0.05). The incidence of adverse events was lower in the ultrasound group compared with the experience and control groups; the difference was statistically significant (P < 0.05). Ultrasound dynamic monitoring of IVCD and collapse with sniff can accurately assess blood volume status, and provide guidance for dehydration adjustments in CRRT and rapid relief of heart failure symptoms in patients with combined renal and acute heart failure.

Cardiology Research Institute, Tomsk National Research Medical Center

Aim. To assess the prognostic role of cardiac biomarkers (galectin-3, soluble ST2 (sST2), and N-terminal pro-brain natriuretic peptide (NT-proBNP)) in risk stratification of adverse cardiovascular events (CVEs) in patients with heart failure (HF) after implantation of an automatic implantable cardioverter-defibrillator (AICD) within 12-month follow-up period.Material and methods. The study included 57 patients (men, 41; mean age, 65 (59; 68) years) with coronary artery disease and NYHA class II-III HF with left ventricular ejection fraction of 34 [26; 40]%. All patients were implanted with AICD. Serum levels of NT-proBNP, sST2, and galectin-3 were determined by enzyme immunoassay prior to AICD implantation.Results. It has been established that in order to stratify the risk of unfavorable HF in patients after AICD implantation for 12-month follow-up, all three studied biomarkers can be considered as prognostic factors. Thus, an increase in the level of NT-proBNP ≥1046,6 pg/ml (AUC=0,68; p=0,009), sST2 ≥34,43 ng/ml (AUC=0,78; p&lt;0,0001) and galectin-3 ≥11,6 ng/l (AUC=0,72; p=0,0014) predicts a high risk of adverse CVEs. The combination of sST2 and galectin-3 increased the predictive value of the analysis (AUC=0,84; p&lt;0,0001), while the addition of NTproBNP did not increase the accuracy of risk stratification.Conclusion. The determination of the combination of galectin-3 and sST2 can potentially help identify a group of patients with HF after AICD implantation with a high risk of adverse CVEs for intensification and optimization of treatment.

Clinical assessment for pulmonary hypertension in interstitial lung disease.

Pulmonary hypertension (PH) is an important complication of interstitial lung disease (ILD), as its development confers a poor prognosis. There are no specific recommendations for methods of assessment for PH in ILD populations. To determine current assessment practices for PH in an Australian ILD centre. In the Austin Health ILD database, 162 consecutive patients with idiopathic pulmonary fibrosis or connective tissue disease-associated ILD were identified and retrospectively evaluated for methods of PH assessment with transthoracic echocardiography (TTE), serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and right heart catheterisation (RHC) in relation to patient demographic and physiological parameters. The median follow-up was 30 (14.4-56.4) months. At baseline, vital capacity was 80.0 ± 18.4% predicted, and diffusing capacity for carbon monoxide was 59.6 ± 15.2% predicted. Evaluation for PH was performed in 147 (90.7%) patients, among whom 105 (64.8%) had TTE performed at least once. At the initial TTE, 33.7% patients had high probability of PH, defined as RVSP >40 mmHg + RAp and/or right ventricular dysfunction. At the time of the most recent TTE, these criteria were met in 45 (52.3%) patients. Elevated serum NT-proBNP levels during the first year were observed in 47 (38.8%) patients. Only 14 (8.6%) patients had RHC. Our institutional PH assessment practice in ILD demonstrates a substantial prevalence of probable PH at baseline. As new therapies emerge for the treatment of PH in ILD, well-defined screening practices are important in this population for early identification and optimal management.

Mitral Regurgitation and Serum N-Terminal Pro-Brain Natriuretic Peptide Levels in Children: A Modification of Adult Criteria.

Mitral regurgitation can result from congenital heart disease, rheumatic valve disease, or other congenital malformations of the mitral valve. Faulty valves require surgical repair or replacement. However, echocardiographic and biochemical parameters that inform surgical decision-making for adults may not be appropriate for children. To investigate whether adult parameters can be used in children, we correlated echocardiographic parameters with serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in children with chronic mitral regurgitation. Our sample comprised 45 patients and 38 healthy children. M-mode measurements, left atrial and left ventricular volumes, and Doppler and tissue Doppler echocardiograms were collected. We graded mitral regurgitation according to European Association of Echocardiography recommendations and indexed effective regurgitant area, vena contracta, and regurgitant volume to body surface area. Patients were grouped by regurgitation severity (mild vs moderate or severe) and left ventricular end-systolic dimension (normal vs enlarged). The NT-proBNP level was higher in patients than in controls (P=0.003), higher in patients with moderate or severe regurgitation (P=0.02), and higher in patients with an enlarged left ventricle (P=0.003). Serum NT-proBNP levels correlated with effective regurgitant area (r=0.47; P=0.002), vena contracta width (r=0.46; P=0.003), regurgitant volume (r=0.32; P=0.04), left ventricular end-systolic diameter (r=0.58; P <0.001), and left atrial diameter (r=0.62; P <0.001). An NT-proBNP value of 66 pg/mL differentiated the mild regurgitation group from the moderate or severe regurgitation group. Our results correlating NT-proBNP and echocardiographic parameters indexed to body surface area indicate that these adult criteria can be used in children to grade mitral regurgitation and inform surgical decision-making.

Level and correlations of soluble suppression of tumorigenicity 2 protein in heart failure and its relationship with clinical and paraclinical characteristics of patients

Aim. To establish the correlations of the soluble suppression of tumorigenicity 2 protein (sST2) and N-terminal pro-brain natriuretic peptide (NT-proBNP) with some clinical and paraclinical characteristics of patients with heart failure (HF).Material and methods. The study included 130 patients with HF (men — 54, women — 76, mean age, 64,3±8,3 years) from the regional registry of HF patients in the Voronezh Oblast. All patients underwent echocardiography and general clinical investigations. In addition, the serum levels of sST2 and NT-proBNP were determined and their correlations with other parameters were studied.Results. The blood level of sST2 in HF patients was 339,8 [266;405] pg/ml. In the study sample of patients with HF, sST2 levels correlated with right atrial (r=0,49) and right ventricular (r=0,32) sizes, left ventricular end-diastolic dimension (r=0,34) and volume (r=0,33), left ventricular early diastolic filling rate (r=-0,35), blood calcium level (r=-0,55) and functional class of exertional angina (r=-0,37).Conclusion. The data obtained may indicate a pathogenetic relationship between sST2 and systolic and diastolic dysfunction of the left ventricle and right heart. 

Effect of β-blocker therapy on the level soluble ST2 protein in the blood serum in patients with heart failure with preserved and mildly reduced ejection fraction

Aim. To study the prognostic value of high serum concentration of soluble ST2 protein (sST2) in the development of cardiovascular events after endovascular myocardial revascularization and the possibility of using this biomarker as a target for β-blocker therapy in patients with chronic heart failure (CHF) with preserved (HFpEF) and mildly reduced (HFmrEF) left ventricular ejection fraction.Materials and methods. The study included 72 patients (aged 57–69 years, 81.94% were men) with class I–III CHF of ischemic etiology with HFpEF and HFmrEF. The patients were admitted to the cardiology department for endovascular myocardial revascularization. Before myocardial revascularization, serum concentrations of sST2 and N-terminal pro-brain natriuretic peptide (NT-proBNP) in all patients were analyzed by enzyme-linked immunosorbent assay (ELISA). Doses of β-blockers used in all patients were recalculated into a total daily dose equivalent to metoprolol succinate. Patients were divided into 2 groups depending on the median equivalent dose of metoprolol succinate (“high” ≥ 100 mg / day and “low” &lt; 100 mg / day).Results. In patients of group 1, the serum concentration of sST2 was 30.7% higher (p &lt; 0.001) than in patients of group 2 (40.26 [34.39; 48.92] ng /ml and 27.9 [23.05; 35.27] ng / ml, respectively), the serum NT-proBNP level in group 1 was 22.8% higher (p = 0.049) than in group 2 (167 [129; 330] ng / ml vs. 129 [125; 147] ng / ml, respectively). In patients receiving an equivalent dose of metoprolol succinate &lt; 100 mg / day, the incidence of cardiovascular events was 34% higher (p = 0.002) than in patients receiving an equivalent dose of metoprolol succinate ≥ 100 mg/day. The ROC analysis showed that serum sST2 level ≥ 34.18 ng / ml (sensitivity 78.0%, specificity 90.0%, area under the curve (AUC) 0.906; p &lt; 0.0001) predicts a high risk of cardiovascular events within one year. However, the serum NT-proBNP level was not an informative predictor of cardiovascular events. Conclusion. It was confirmed that increased sST2 serum concentration has high prognostic value in the development of cardiovascular events within a year after endovascular myocardial revascularization. The possibility of using this biomarker as a target for β-blocker therapy in patients with HFpHF and HFmrEF was substantiated. Aggressive use of β-blockers in the group of patients with HFpEF and HFmrEF and sST2 overexpression is preferable in order to reduce the incidence of cardiovascular events.

The Significance of The Detection of Serum Lactate Dehydrogenase, Hypersensitive C-Reactive Protein, and N-Terminal Pro-Brain Natriuretic Peptide for the Evaluation of the Severity and Progression of Pediatric Patients with Traumatic Brain Injury.

This study aimed to investigate changes in the levels of serum lactate dehydrogenase (LDH), hypersensitive C-reactive protein (hs-CRP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) in pediatric patients with traumatic brain injury and the clinical significance of detecting these changes for the evaluation of injury severity and patient progress. A retrospective study was conducted on 40 pediatric patients admitted to the Tongren Hospital of China Capital Medical University with traumatic brain injury between January 2018 and December 2019. Immunoturbidimetric assay and electrochemiluminescence were used to detect the serum levels of LDH, hs-CRP, and NT-proBNP. Correlation analysis was used to determine the degree of association between the indicators and the sensitivity and specificity of each indicator. The serum levels of LDH, hs-CRP, and NT-proBNP in the poor-prognosis group were higher than those in the good-prognosis group, and the differences were statistically significant (P < 0.05). The detection of serum LDH, hs-CRP, and NT-proBNP might be of great significance for the evaluation of the severity of a traumatic brain injury, disease progression, and the prognosis of pediatric patients with traumatic brain injury. The combined detection of the relevant indicators could provide more effective sensitivity and specificity and therefore offer better guidance and assistance in clinical practice.

The relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and diastolic heart failure in patients with COVID-19.

Diastolic dysfunction has been reported in patients with COVID-19. Due to the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the diagnosis of heart failure, this study investigated the relationship between serum NT-proBNP levels and diastolic heart failure in patients with COVID-19. This descriptive-analytical study was performed at Ayatollah Rouhani Hospital in Babol. Fifty-two patients with confirmed COVID-19 diagnosis, who were admitted to the ICU, were included in this study. The primary outcome was about the relationship and predictive role of NT-proBNP and diastolic heart failure in patients with severe SARS-CoV-2 infection. Patients with pro BNP > 125 pg/ml underwent echocardiography, and the relationship between echocardiographic indices and NT-proBNP was assessed as the secondary outcome. Our study showed that plasma NT-proBNP levels in patients with increased diastolic dysfunction were associated with disease severity. It was also found that the cut-off point of NT-proBNP = 799 pg/ml could be a predictor of diastolic dysfunction grades two and three. In this study, patients with a serum NT-proBNP level > 799 had 37 times higher chance of having diastolic dysfunction than those with a serum NT-proBNP < 799. Patients with NT-proBNP > 556 had RV_EA > 2 in echocardiography, indicating increased right-sided filling pressures. Despite the confounding factors in the interpretation of the NT-proBNP level in COVID-19, its level can be used to estimate the presence of high-grade diastolic heart failure on the left side and the right side of the heart and the presence of high filling pressures. Lower levels of NT-proBNP are associated with right-sided diastolic failure.

Simvastatin Combined with Resistance Training Improves Outcomes in Patients with Chronic Heart Failure by Modulating Mitochondrial Membrane Potential and the Janus Kinase/Signal Transducer and Activator of Transcription 3 Signaling Pathways.

Background Chronic heart failure (CHF) is the end stage of cardiac disease with a 5-year mortality rate reaching 50%. Simvastatin is an antioxidant with lipid-lowering effects, which is commonly used to treat CHF. Resistance training is a nondrug treatment for CHF and exerts a positive effect on both the myocardial structure and function. Objective This study is aimed at exploring the effects and outcomes of simvastatin combined with resistance training on the mitochondrial membrane potential (MMP) of peripheral blood lymphocytes and the Janus kinase/signal transducer and activator of the transcription 3 (JAK/STAT3) signaling pathway in patients with CHF. Methods One hundred and eleven patients with CHF were allocated to the control group (CNG) (n = 55) and intervention group (IG) (n = 56) using the random number table method. The CNG received simvastatin treatment only, whereas the IG received simvastatin treatment plus resistance training. Treatment efficacy, diastolic interventricular septal thickness (IVST), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDD), MMP fluorescence intensity, JAK mRNA and STAT3 mRNA relative expression levels, serum C-reactive protein (CRP), galectin-3, interleukin-6 (IL-6), N-terminal–probrain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), and heart-type fatty acid-binding protein (H-FABP) levels were compared in both groups. Results After 6 months of treatment, diastolic IVST, LVDD, and serum levels of CRP, galectin-3, IL-6, NT-proBNP, hs-cTnT, and H-FABP decreased in both groups and were lower in the IG than in the CNG (P < 0.05), whereas LVEF, JAK and STAT3 mRNA relative expression levels, and MMP fluorescence intensity of peripheral blood lymphocytes were higher in the IG than in the CNG (P < 0.05). Conclusion Simvastatin combined with resistance training improves heart function and reduces myocardial damage as well as the occurrence of adverse cardiac events compared with simvastatin alone. The mechanism may be related to the increase of expression of MMP, JAK, and STAT3, the regulation of MMP and JAK/STAT3 signaling pathways in peripheral lymphocytes, the alleviation of mitochondrial damage, and the inhibition of inflammatory response.