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Objective:. Early identification of acute kidney injury (AKI) is essential to improve the prognosis of patients with acute heart failure (AHF). We aimed to determine the utility of neutrophil/lymphocyte ratio (NLR), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), urea, and creatinine (Cr), as well as combinations of these, for the prediction of AKI in patients with AHF. Methods:. A total of 153 patients with AHF under the care of Sun Yat-sen Memorial Hospital, Sun Yat-sen University from October 2009 to October 2019 were included in this retrospective observational study. Their NLR, NT-proBNP, urea, and Cr concentrations were measured on admission. AKI was defined using the Acute Kidney Injury Network criteria. Receiver operating characteristic (ROC) curves, the areas under the curves (AUCs), sensitivity, and specificity were employed to evaluate the ability of each biomarker and their combinations to identify AKI. This study was approved by the Ethics Committee of Sun Yat-sen Memorial Hospital, Sun Yat-sen University (approval No. SYSEC-KY-KS-2021-126) on June 22, 2021. Results:. Forty-six (30.1%) participants developed AKI during hospitalization. The NLR and NT-proBNP of the participants with AKI were higher than those without (NLR: median 7.886 vs 4.717, P

Objectives The determinants of right ventricular (RV) recovery after successful revascularization in ST-elevation myocardial infarction (STEMI) patients are not clear. Besides, the relationship between Troponin T (TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and improvement in RV function is also unknown. This study hypothesizes that a lower TnT and NT-proBNP level would be associated with RV recovery. Methods One hundred forty-eight STEMI patients were included in our study. Echocardiography were performed before and 12–18 weeks after discharge. Patients were divided into three groups according to the changes in tricuspid annular plane systolic excursion (TAPSE) as 53 patients with ≥10% change, 41 patients with 1–9% change, and 54 patients ≤0% change. RV recovery was accepted as ≥10% TAPSE improvement and the predictors of RV recovery were investigated. Results RV recovery was detected in 35.8% of the patients. Low baseline left ventricular ejection fraction (OR: 0.91 [0.84–0.98], p=0.023), NT-proBNP (OR: 0.93 [0.89–0.98], p=0.014), TnT (OR: 0.84 [0.68–0.93], p=0.038), inferior myocardial infarction (OR: 2.66 [1.10–6.40], p=0.028), wall motion score index ratio (OR: 0.93 [0.88–0.97], p=0.002) and post-percutaneous coronary intervention TIMI flow 3 (OR: 5.84 [1.41–24.22], p=0.015) were determined as independent predictors of RV recovery. Being in the high TnT group 4.2 times, and being in the high NT-proBNP group 5.3 times could predict the failure to achieve RV recovery. Furthermore, when high TnT level was combined with high NT-proBNP level, the odds ratio of failure to achieve RV recovery was the highest (OR: 8.03 [2.59–24.89], p Conclusions Lower TnT and lower NT-proBNP level was associated with better improvement in RV function in STEMI patients.

Left ventricle dysfunction is the link between the heart morphological changes and the overt heart failure. Hypertension is one of the main cardio-vascular conditions which can lead to development of left ventricle failure. The study was conducted at outpatient Clinic – Medlife, Memorial Hospital. It intended to compare NT-pro BNP and the ratio E/E’ as markers of diastolic dysfunction in hypertensive patients and normal ejection fraction (EF) and no signs or symptoms of heart failure. Both indexes proved to reflect independently diastolic dysfunction in symptomatic patients with different cardiac diseases but not in asymptomatic hypertensive patients. It was a single-center observational study recruiting 40 participants (20 F 52–70 age, and 20 M 56–67 age). Natriuretic peptides are widely accepted as biomarkers in heart failure with reduced ejection fraction. NT-pro BNP proved to be a very good means of diagnosing exercise-related left ventricular dysfunction (LVD) showing that it could unveil a subclinical LVD, especially in patient with myocardial remodeling. The main goal of this study was to compare the values of NT-pro BNP and E/E’. We have found no correlation between NT-pro BNP and E/E’, both pre-exercise and post-exercise, demonstrating that the later was not a reliable means of diagnosing LVD at effort in aymptomatic hypertensive patients.

Objective: The importance of the NT-proBNP value in detecting patients at risk of developing heart failure (HF) and its importance in guiding medical management to prevent the development of HF. Material and methods: The study is a prospective study and includes 314 patients who was presented at the Bagdasar-Arseni Emergency Hospital for cardiology consultation, by appointment, for a period of 3 years. The inclusion criteria were as follows: essential hypertension (diagnosed more than 5 years before), diabetes mellitus (insulin-deficient or under treatment with oral ant diabetics diagnosed more than 5 years before), ischemic heart disease, mild or moderate valvulopathy (mild or moderate mitral regurgitation and large or moderate aortic stenosis) and permanent or paroxysmal atrial fibrillation. Exclusion criteria were as follows: a previous diagnosis of heart failure or left ventricular systolic dysfunction, and the presence of signs or symptoms of heart failure at the time of enrollment in the study. Patients were randomized into 2 groups, a control group and a intervention group. Patients in the intervention group were managed according to the NT-proBNP value, and patients in the control group received the conventional intervention. Patients were monitored for 3 years and the following objectives were pursued: new diagnosis of heart failure, systolic or diastolic dysfunction of the left ventricle and hospitalization for cardiovascular pathology. Results: After 3 years, in the control group there were 40 patients (25.5%) who developed HF, compared to 28 patients (17.8%) in the intervention group. In the control group, 60 patients (38.2%) were diagnosed with left ventricular systolic dysfunction, compared to 43 patients (27.4%) in the intervention group. Regarding left ventricular diastolic dysfunction, in the control group there were 98 patients (62.4%), and in the intervention group there were 80 patients (51.0%). Also, the rate of hospitalizations for cardiovascular pathology was higher in the control group, 56 patients (35.7%), compared to 33 patients (21.0%) in the intervention group. Discussions: The incidence of heart failure, left ventricular systolic or diastolic dysfunction, or hospitalizations for cardiovascular events, was lower in the intervention group, in which patients were managed according to the NT-proBNP value, compared to patients in the control group who received conventional intervention. Conclusions: The NT-proBNP biomarker may be useful in the medical management of patients for the prevention of heart failure.

Hypertension is one of the main risk factors for developing left ventricle failure. The study was conducted at outpatient Clinic – Medlife, Memorial Hospital. It was an observational study. We analyzed the exercise-induced secretion of NT-pro BNP in hypertensive patients with normal ejection fraction and no symptoms or signs of heart failure. Comparing the levels of NT-pro BNP before and after exercise proved to be a good mean for diagnosing left ventricular dysfunction (LVD) in hypertensive patients with left ventricular remodeling.

Background Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at 20 weeks’ gestation predict adverse cardiovascular (CV) complications during pregnancy in women with congenital heart disease (CHD). To improve early risk assessment in these women, we investigated the predictive value of first-trimester NT-proBNP for CV complications and its association with ventricular function during pregnancy. Methods Pregnant women with CHD, previously enrolled in a prospective national study or evaluated by an identical protocol, were included. Clinical data, echocardiographic evaluation and NT-proBNP measurements were obtained at 12, 20 and 32 weeks’ gestation. Elevated NT-proBNP was defined as > 235 pg/ml (95th percentile reference value of healthy pregnant women in the literature). Results We examined 126 females (mean age 29 years). Elevated NT-proBNP at 12 weeks was associated with CV complications (n = 7, 5.6%, odds ratio 10.9, p = 0.004). Arrhythmias were the most common complication (71%). The negative predictive value of low NT-proBNP to exclude CV complications was 97.2%. In women with CV complications, NT-proBNP levels remained high throughout pregnancy, while a decrease was seen in women without CV complications (p p p = 0.012). Conclusions In this study, first-trimester NT-proBNP levels were associated with adverse CV complications and a decline in subpulmonary ventricular function later in pregnancy in women with CHD. Early NT-proBNP evaluation is useful for tailored care in pregnant women with CHD.

Introduction Serum N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels have been associated with the progression of kidney impairment among patients with chronic kidney disease (CKD), but only a few studies have investigated the association between serum NT-proBNP levels and incident CKD in general populations. Methods A total of 2486 Japanese community-dwelling residents ≥40 years of age without CKD at baseline were followed up by repeated annual health examinations for 10 years. Participants were divided into 4 groups according to serum NT-proBNP levels. CKD was defined as an estimated glomerular filtration rate (eGFR), Graphical abstract

Background:Although cardiac catheterisation (cath) is the diagnostic test for pulmonary hypertension, it is an invasive procedure. Echocardiography (echo) is commonly used for the non-invasive diagnosis of pulmonary hypertension but maybe limited by lack of adequate signals. Therefore, emphasis has been placed on biomarkers as a potential diagnostic tool. No prior paediatric studies have simultaneously compared N-terminal pro-B-type-natriuretic peptide (NTproBNP) with cath/echo as a potential diagnostic tool. The aim of this study was to determine if NTproBNP was a reliable diagnostic tool for pulmonary hypertension in this population.Methods:Patients were divided into Study (echo evidence/established diagnosis of pulmonary hypertension undergoing cath) and Control (cath for small atrial septal defect/patent ductus arteriosus and endomyocardial biopsy post cardiac transplant) groups. NTproBNP, cath/echo data were obtained.Results:Thirty-one patients met inclusion criteria (10 Study, 21 Control). Median NTproBNP was significantly higher in the Study group. Echo parameters including transannular plane systolic excursion z scores, pulmonary artery acceleration time and right ventricular fractional area change were lower in the Study group and correlated negatively with NTproBNP. Receiver operation characteristic curve analysis demonstrated NTproBNP > 389 pg/ml was 87% specific for the diagnosis of pulmonary hypertension with the addition of pulmonary artery acceleration time improving the specificity.Conclusions:NTproBNP may be a valuable adjunctive diagnostic tool for pulmonary hypertension in the paediatric population. Echo measures of transannular plane systolic excursion z score, pulmonary artery acceleration time and right ventricular fractional area change had negative correlations with NTproBNP. The utility of NTproBNP as a screening tool for pulmonary hypertension requires validation in a population with unknown pulmonary hypertension status.

Background: Utility of N-terminal pro B-type natriuretic peptide (NT-proBNP) in the emergency department (ED) as a prognostic marker for acute breathlessness. Methods: An observational study was conducted on 241 patients presenting to ED with acute breathlessness. NT-proBNP levels were measured and patients were divided into two groups as per NT-proBNP measurement: Group-1(high) and Group-2(normal) as per agerelated pre-determined cut-offs. Primary outcomes including Length of stay (LOS), intervention and death were recorded and compared. th Secondary outcome in terms of readmission and death was done on the 30 day. Statistical analysis was done using univariate analysis and multivariate logistic regression. ROC curve analysis was performed for optimal cut-off for mortality within 30 days. Out of 241 patients, Results: 170 (71%) patients had high NT-proBNP levels. Group-1 had high LOS (7.0 day compared to 4.5 days, p=0.002), increased ICU admission (OR=77, 95 % CI : 8.2-162.4, p=0.0001), increased requirement of ventilator (OR=3, 95 % CI :1.3-7.1, p=0.002) noninvasive ventilator (OR=4.7, 95 % CI :2.2-9.2, p=0.0001) and dialysis (OR=8.1, 95 % CI : 1.1-160, p=0.016). Logistic regression also conrmed that NT-proBNP is a good predictor for increase death within 30 days (OR=2.80, 95 % CI : 1.2, 6.4, p=0.015) and increase LOS ≥7 days (OR=2.3, 95 % CI : 1.2-4.4, p=0.012) after adjustment for patient age, sex and underlying co-morbidities. For predicting mortality within 30 days, its cut-off values in Receiver operating characteristics (ROC) curve was 1655pg/ml (Sensitivity: 72%, Specicity:48.0%, AUCs: 62.5%, p=0.006). NT-proBNP levels are a Conclusion: rapid and good predictor of morbidity and mortality within 30 days. A single determination of the NT-proBNP level was sufcient to identify high risk patients with a poor prognosis at the time of admission in the ED.

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

Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) improves emergency room diagnosis and is a prognostic marker of acutely decompensated heart failure (HF) after hospitalization. We tried to assess the prognosis in heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) using the biomarker. Methods: Patients were categorized into HFpEF (left ventricular ejection fraction [LVEF] ≥50%) (n = 102), HF with midrange EF (LVEF of 40%–49%) (n = 106), and HFrEF (LVEF ≤40%) (n = 112) as per the ESC classification of HF subtypes. Prognosis by absolute and percentage change in NT-proBNP at admission and at the 10th day of treatment was found in 3-month follow-up. Mortality after discharge was also assessed. Results: Among all HF groups, a reduction of NT-proBNP

Background: Heart failure is a major health problem in the world. It is associated with high morbidity and high mortality especially in elderly patients. Most studies reported using N terminal pro-B type natriuretic peptide (NT-proBNP) in diagnosis of heart failure, but about of these tests in determining classification of severity of heart failure in the elderly remain unclear. Objective: To determine the differences NT-pro BNP levels based on the severity of diease of heart failure in elderly patients. Methods: This is an observational study with cross sectional design. Subjects were patients with diagnosed heart failure and aged = 60 years. Patients were divided into two groups, mild and severe heart failure groups according to severity of heart failure in New York Heart Association (NYHA) class. The NT Pro-BNP levels were measured for all subjects in both groups. Data was analyzed with using unpaired t test and was considered significant if p

BACKGROUND: We recently determined that the DASH diet has beneficial effects on cardiac biomarkers. The effects of sodium reduction on cardiac biomarkers, alone or combined with the DASH diet, are unknown. OBJECTIVES: Our objective was to determine the effects of sodium reduction and the DASH diet, alone or combined, on biomarkers of cardiac injury, strain, and inflammation. METHODS: DASH-Sodium was a controlled feeding study in adults with SBP 120–159 mm Hg and DBP 80–95 mm Hg, randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4 weeks. Body weight was kept constant. At the 2,100 kcal level, the three sodium levels were low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). Outcomes were 3 cardiac biomarkers: high-sensitivity cardiac troponin I (hs-cTnI, measure of cardiac injury), N-terminal b-type pro natriuretic peptide (NT-proBNP, measure of strain), and high-sensitivity C-reactive protein (hs-CRP, measure of inflammation), collected at baseline and at the end of each feeding period. RESULTS: Of the original 412 participants, mean age was 48 yr; 56% were women, and 56% black. Mean baseline SBP/DBP was 135/86 mmHg. DASH (versus control) reduced hs-cTnI by 18% (95%CI: −27%,−7%) and hs-CRP by 13% (95%CI: −24%,−1%), but not NT-proBNP. In contrast, lowering sodium from high to low levels reduced NT-proBNP independently of diet (19%; 95%CI: −24%,−14%), but did not alter hs-cTnI and mildly increased hs-CRP (9%; 95%CI: 0.4%, 18%). Combining both DASH with sodium reduction lowered hs-cTnI by 20% (95%CI: −31%,−7%) and NT-proBNP by 23% (95%CI: −32%,−12%), while hs-CRP was not significantly changed (−7%; 95%CI: −22%, 9%) compared to the high sodium-control diet. CONCLUSIONS: Combining a DASH dietary pattern with sodium reduction can lower two distinct mechanisms of subclinical cardiac damage: injury and strain, while DASH alone reduced inflammation.

This is the peer reviewed version of the following article: Aimo, A., Januzzi, J.L., Vergaro, G., Richards, A.M., Lam, C.S.P., Latini, R. ... Emdin, M. (2020). Circulating levels and prognostic value of soluble ST2 in heart failure are less influenced by age than N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T, European Journal of Heart Failure, which has been published in final form at https://doi.org/10.1002/ejhf.1701. . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Aims - N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), high‐sensitivity troponin T (hs‐TnT) and soluble suppression of tumorigenesis‐2 (sST2) predict outcome in chronic heart failure (HF). We assessed the influence of age on circulating levels and prognostic significance of these biomarkers. Methods and results - Individual data from 5301 patients with chronic HF and NT‐proBNP, hs‐TnT, and sST2 data were evaluated. Patients were stratified according to age: Conclusions - Soluble ST2 is less influenced by age than NT‐proBNP or hs‐TnT; all these biomarkers predict outcome regardless of age. The use of age‐ and outcome‐specific cut‐offs of NT‐proBNP, hs‐TnT and sST2 allows more accurate risk stratification than NT‐proBNP alone or the combination of NT‐proBNP and hs‐TnT.

Background: N-terminal probrain natriuretic peptide, which is a neurohormone produced mainly by the heart, is increased in acute ischemic cerebrovascular disease. Here we aimed to investigate the relationship of N-terminal probrain natriuretic peptide levels with cerebrovascular disease subtypes, infarct volume, and prognosis in cerebrovascular disease, and to determine if N-terminal probrain natriuretic peptide could be a biomarker for ischemic cerebrovascular disease. Methods: Consecutive 105 patients with a diagnosis of acute ischemic cerebrovascular disease and 50 healthy controls were examined for serum N-terminal probrain natriuretic peptide concentration, cerebrovascular disease subtypes, infarct volumes, and clinical outcomes with the National Institute of Health Stroke Scale assessment. Results: Mean N-terminal probrain natriuretic peptide values of cardioembolic group were significantly higher than lacunar infarct group ( P < .005) and transient ischemic attack group ( P = .005). There was a relation between worsening in the National Institute of Health Stroke Scale and elevation at N-terminal probrain natriuretic peptide ( P = .001). However, between N-terminal probrain natriuretic peptide levels and infarct volume, significant correlation was not detected ( P = .44). Conclusion: N-terminal probrain natriuretic peptide can be used as a valuable marker to distinguish between cardioembolic infarct and lacunar infarct. In addition, N-terminal probrain natriuretic peptide levels might be used as a biomarker for differential diagnosis of transient ischemic attack group and to provide insight into the prognosis.

Cirrhotic cardiomyopathy can be explained as chronic dysfunction of the heart exhibited as blunted response to contractile function of the heart during Strain and decreased diastolic rest with odd electrophysiological (QT interval prolongation) adjustments, all taking region within the absence of an present cardiac disorder and irrespective of the reason of cirrhosis. Chronic Liver Disease is a process of revolutionary destruction and regeneration of the liver parenchyma leading to extensive spectrum of changes like persistent hepatitis, cirrhosis or hepatocellular carcinoma. Cirrhosis is one of the maximum common presentation of persistent liver sicknesses. It is characterized with the aid of reduced contractile responsiveness to stress, altered diastolic relaxation and electrophysiological abnormalities (QT interval prolongation) all happening within the absence of existing cardiac sickness. At gift there is evidence that, compromised liver feature and portal high blood pressure with splanchnic vasodilatation lead to the improvement of the hyperdynamic adjustments. Also other elements like increased sympathetic pastime, accelerated blood go with the flow and presence of arteriovenous communications can play extensive role in pathogenesis. Many pathophysiological mechanisms like decreased beta-receptor motion seem to be involved within the cardiac and autonomic disorder. Cirrhotic cardiomyopathy may be proven through tissue Doppler imaging and it's far quality tested with the aid of pharmacological or bodily strain. Diagnosis is done through 2D echocardiography, electrocardiography and cardiac serum markers (Troponin I, NT pro BNP). Elevation of troponin I is accepted to be a marker of cirrhotic cardiomyopathy. Troponin I proves to be a significant marker of myocardial injury in chronic liver disease patients. Although NT pro BNP is elevated as it can be elevated in fluid overload state related to liver disease it is unlikely to take it significant. The cardiovascular changes in the present study indicates that there was myocardial characterised by elevated troponin I.

Objectives Assessment of heart size in kittens is important, and there is a need for reference intervals (RIs) to prevent misinterpretation of cardiomegaly in this patient population. The purpose of this study was to generate RIs for echocardiographic and radiographic quantification of cardiac size in healthy kittens. Methods In total, 88 kittens aged 6–16 weeks were enrolled in this study. Physical examination, and radiographic and echocardiographic evaluations were performed without sedation. Thoracic radiographs and echocardiographic images were measured to establish RIs for vertebral heart score (VHS), cardiac thoracic ratio (CTR) and multiple echocardiographic variables. N-terminal pro B-type natriuretic peptide (NT-proBNP) was measured. Statistical correlations between echocardiographic parameters and age, body weight and sex were all evaluated and RIs were generated. Results Low-grade heart murmurs were appreciated in 26/88 kittens (29.5%). Kittens had a median VHS of 9.5 vertebrae (95% RI 8.0–10.9) and a median CTR of 67.2% (95% RI 54.4–79.8%). Measured NT-proBNP levels were comparable to healthy adult cats with a median of 31 pmol/l (upper reference limit 75 pmol/l). Multiple moderate-to-strong correlations between body weight and age with various echocardiographic parameters were observed and allometric scaling was performed for body weight. RIs for echocardiographic parameters were generated based on patient weight using allometric scaling formulas. Tricuspid valve regurgitation was a common finding and was present in 37.5% (n = 33) of the kittens. Conclusions and relevance This study establishes RIs for thoracic radiograph assessment, echocardiography and cardiac biomarkers in kittens, which fills a critical gap in the veterinary literature. The VHS reported in this study is higher than previously reported for adult cats.

The association between uric acid and N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) in patients with unstable angina pectoris (UAP) is unclear.We recruited 260 patients with UAP admitted to the first affiliated Hospital of Guangxi Medical University from February 2018 to August 2018. According to the level of uric acid, patients were divided into 4 groups (Q1 = 48.00-305.00 μmol/L; Q2 = 310.00-405.00 μmol/L; Q3 = 408.00-513.00 μmol/L; Q4 = 514.00-4330.00 μmol/L). The differences of NT-proBNP between groups and the relationship with cardiac function were compared.The average age of the 260 patients enrolled was 75.04 years. The NT-proBNP of the 4 groups showed an increasing trend, and there were significant differences between the 4 groups (0.001). On the other hand, with the increase of cardiac function (New York Heart Association), the levels of NT-proBNP and uric acid also showed an upward trend (all P0.05). Pearson correlation analysis showed that there was a positive correlation between uric acid log10 transform and NT-proBNP log10 transform (r = 0.272, P0.001). After adjusting the potential confounding factors, elevated uric acid was still significantly related to the increase of NT-proBNP (Q2 versus [vs.] Q1: OR = 469.64, 95%CI -1396.77 to 2336.05; Q3 vs. Q1: OR = 1166.53, 95%CI -726.12 to 3059.18; Q4 vs. Q1: OR = 3204.78, 95%CI 1240.86-5168.70). In subgroup analysis, the relationship between uric acid and NT-proBNP was significant in males, but no difference was observed in females.In male patients with UAP, elevated uric acid is related to the increase of NT-proBNP, but this phenomenon is not obvious in female patients.

Many clinicians use the Canadian Syncope Risk Score to evaluate emergency department patients with syncope. Other studies suggest that the score might work better by adding blood levels of B-type n...

OBJECTIVE: To assess the association between serially measured N-terminal pro-B-type natriuretic peptide (NT-proBNP) serum levels and disease severity in children with pulmonary arterial hypertension (PAH), and to assess its predictive value for death or (heart-)lung transplantation.STUDY DESIGN: This was a longitudinal cohort study of the Dutch National Network for Pediatric Pulmonary Hypertension conducted between 2003 and 2017. Data on NT-proBNP and disease severity markers (World Health Organization Functional Class [WHO-FC], 6-minute walking distance [6MWD], and tricuspid annular plane systolic excursion [TAPSE]) were collected every 3 to 6 months from 82 children with PAH. The outcome measure was death or (heart-)lung transplantation. Also, NT-proBNP levels over time were compared between survivors and nonsurvivors.RESULTS: The median patient age was 8.8 years (IQR, 4.6-13.5 years), and 61% were female. The median duration of follow-up was 4.8 years (IQR, 1.9-10.0 years). At all times during the course of disease, higher NT-proBNP levels were associated with higher WHO-FC (β = 0.526; 95% CI, 0.451-0.600), lower 6MWD z-score (β = -0.587; 95% CI, -0.828 to -0.346), lower TAPSE z-score (β = -0.783; 95% CI, -1.016 to -0.549), and elevated risk of death or (heart-)lung transplantation (hazard ratio 16.61; 95% CI, 7.81-35.33). Compared with survivors, nonsurvivors had NT-proBNP levels that were higher at first measurement and increased exponentially over time (P = .005). Changes in NT-proBNP serum level over time were predictive of outcome.CONCLUSIONS: Throughout the disease course of pediatric PAH, serial measurements of NT-proBNP are associated with disease severity and transplant-free survival. Monitoring NT-proBNP levels over time provides important prognostic information that can support clinical decision making in combination with other established prognostic markers.

Aim. To evaluate the dynamics and prognostic significance of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in patients with severe abdominal sepsis.Methods. We analysed survey data of 54 patients (28 men and 26 women) aged 64.5 years [56.25–78.00] with abdominal sepsis or septic shock. Disease severity scored according to the Acute Physiology and Chronic Health Evaluation II criteria was 16.3 ± 0.8 and according to the Sequential Organ Failure Assessment (SOFA) was 3 [3–6]. Statistical analysis of these data was performed using correlation analysis, logistic regression and receiver operating characteristic analysis.Results. Serum NT-proBNP level during the 1st week following admission to the intensive care unit (ICU) exceeded normal values, i.e. 2,570 [116.25–6,559.5] to 4,600 [1,680–18,200] pg/ml. At all disease stages, serum NT-proBNP level correlated with sepsis severity scores (SOFA), procalcitonin (PCT) levels, lactatemia, mean arterial pressure, heart rate and inotropic and vasoactive–inotropic scales (rho = 0.329–0.433; p < 0.02). On ICU days 3–4, serum NT-proBNP level of >5100 pg/ml was associated with increased risk of mortality [65.6%–88.2%; area under the curve (AUC) = 0.806; р < 0.0001]. Similarly, during this interval, elevated serum NT-proBNP level was associated with the use of inotropic drugs (OR = 1.0001, 95% CI = 1.000–1.0002, p < 0.0059). Notably, we found that 76.9%–79.0% of the patients with serum NT-proBNP level of >5250 pg/ml were receiving inotropic drugs including adrenaline, dopamine and dobutamine. We were unable to identify a specific association between serum NT-proBNP level and norepinephrine administration. On ICU days 7 and 8, among patients with serum NT-proBNP level of >3450 pg/ml, we observed a very close relationship between serum NT-proBNP level and PCT (sensitivity = 63.6%, specificity = 66.7%, AUC = 0.708; р = 0.0041).Conclusion. Serum NT-proBNP level is considerably elevated in patients with abdominal sepsis or septic shock. NT-proBNP level was associated with both traditional indicators of sepsis severity and indicators characterising the state of systemic circulation. Notably, serum NT-proBNP level correlates with cardiac failure and inotropic drug requirement. Although the mechanisms underlying the observed increases in serum NT-proBNP level remain unclear, the present findings indicate that this mediator is clearly a significant biomarker and predictor of adverse outcomes related to abdominal sepsis and septic shock.Received 22 January 2020. Revised 27 January 2020. Accepted 11 February 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and study design: I.N. Tyurin, D.N. Protsenko, I.A. KozlovData collection and analysis: I.N. Tyurin, S.A. Rautbart, S.N. ShuryginStatistical analysis: I.N. Tyurin, S.A. RautbartDrafting the article: I.N. Tyurin, D.N. Protsenko, I.A. Kozlov, S.N. ShuryginCritical revision of the article: I.N. Tyurin, I.A. KozlovFinal approval of the version to be published: I.N. Tyurin, S.A. Rautbart, D.N. Protsenko, S.N. Shurygin, I.A. Kozlov

Objective Numerous studies have reported an association between common carotid artery (CCA) parameters and atherosclerotic cardiovascular disease (CVD). However, the association between CCA parameters and hemodynamic stress on the left ventricle in elderly patients remains unclear. Methods We assessed CCA parameters, including the height-adjusted CCA interadventitial diameter (diameter/height), mean intima-media thickness (IMT), number of plaques, plaque score, resistance index (RI), and pulsatility index (PI) with ultrasonography, using serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels as a marker for hemodynamic stress on the left ventricle in 1,315 participants ≥70 years old without CVD. Of these participants, 706 had hypertension, defined as taking antihypertensive medications, having a systolic blood pressure ≥140 mmHg, and/or having a diastolic blood pressure ≥90 mmHg. Results After adjusting for the confounding factors, the CCA interadventitial diameter/height was significantly associated with the log NT-proBNP in both the normotensive group (β=0.125, p=0.002) and hypertensive group (β=0.080, p=0.029). The RI was significantly associated with the log NT-proBNP in the hypertensive group (β=0.176, p

Stroke is a leading cause of mortality and morbidity. Stroke may be ischemic or hemorrhagic. Ischemic stroke may be due to cardioembolism, large vessel disease, small vessel disease or multiple pathologies. Of them, cardioembolism is the commonest etiology, accounting for up to 40% of all ischemic strokes, having higher recurrence rates as well as poorer outcomes. Atrial brillation is the commonest cause of cardioembolism. The treatment also involves anticoagulants and not antiplatelets. Unfortunately detection of cardioembolism requires complicated long term monitoring through devices to detect paroxysmal atrial brillation, which is as deadly as persistent atrial brillation. The use of biomarkers would simplify the process of detecting cardioembolism, leading also to earlier detection. NT-pro BNPis one such biomarker, which has been shown to be useful in identifying cardioembolic stroke within 72 hrs of symptom onset. This review addresses the role of NT-pro BNP in the detection of cardioembolic stroke

IntroductionPrecapillary pulmonary hypertension (PH) implies a worse prognosis in myeloproliferative neoplasms (MPN). N-terminal pro-B-type natriuretic peptide (NT-proBNP) is elevated in cardiopulmonary involvement. In MPN patients with precapillary PH, elevated vascular endothelial growth factor (VEGF) values, but in left heart (LH) disease patients, decreased values were reported. Our aim was to determine whether a combination of NT-proBNP and VEGF is suitable for the detection of the precapillary forms of PH in MPN patients.Material and methodsEighty-one MPN patients were investigated. Pulmonary hypertension was defined as Doppler-derived systolic pulmonary artery pressure (sPAP) ≥ 40 mm Hg. Patient groups with cardiopulmonary involvement (precapillary PH, PH due to LH disease, left ventricular ejection fraction ResultsIn nine patients PH was associated with LH disease. In two patients precapillary PH was found with extremely high NT-proBNP values. NT-proBNP significantly correlated with sPAP (r = 0.550; p ConclusionsNT-proBNP levels reflect cardiopulmonary involvement with high accuracy, but the combination of NT-proBNP and VEGF is not suitable for the detection of precapillary PH as the diagnostic power of VEGF is limited. Highly elevated NT-proBNP levels may suggest precapillary PH but further investigation is necessary for the exclusion of LH disease or atrial fibrillation.

Background Elevated levels of B-type natriuretic peptide (BNP) and NT-pro-BNP can predict an increased risk of cardiovascular events and ischemic stroke. The limited reliability to predict the risk of stroke after a transient ischemic attack (TIA) justifies the objective of our study to determine the role of NT-pro-BNP in patients with TIAs. Methods From our prospective stroke registry, we performed a retrospective study in all patients with the diagnosis of TIA admitted to the Stroke Unit of our Hospital between January 2008 and March 2018. NT-pro-BNP was determined in the first hours after TIA. The endpoint was the development of stroke during the follow-up. Results 381 patients were included. Mean time of follow-up was 36.8 (±16.4) months. 224 patients were hospitalized due to a stroke during the follow-up, and 157 were not. NT-pro-BNP serum levels were higher in patients who suffered a stroke compared to those who did not (p ≪ 0.001). We also found greater levels of this marker the earlier the stroke happened (p = 0.024). A cut-off point of 800 pg/mL of NT-pro-BNP predicted a stroke with a sensitivity of 64% and a specificity of 79% (p ≪ 0.001), and was independently associated with higher risk of stroke after a TIA (OR: 6.65, p ≪ 0.001). This association persisted for different etiopathogenic TIA groups (cardioembolic: OR 26.12, p ≪ 0.001; undetermined: OR 4.87, p = 0.006; atherothrombotic: OR 1.67, p = 0.044). Conclusions The early determination of NT-pro-BNP is a simple and very useful alternative to predict the prognosis after TIA regardless of the etiopathogenesis of the TIA.

Background: Effective therapies for HFrEF usually reduce NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, and it is important to establish whether new treatments are effective across the range of NT-proBNP. Methods: We evaluated both these questions in the DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) trial. Patients in New York Heart Association functional class II to IV with a left ventricular ejection fraction ≤40% and a NT-proBNP level ≥600 pg/mL (≥600 ng/L; ≥400 pg/mL if hospitalized for HF within the previous 12 months or ≥900 pg/mL if atrial fibrillation/flutter) were eligible. The primary outcome was the composite of an episode of worsening HF or cardiovascular death. Results: Of the 4744 randomized patients, 4742 had an available baseline NT-proBNP measurement (median, 1437 pg/mL [interquartile range, 857–2650 pg/mL]). Compared with placebo, treatment with dapagliflozin significantly reduced NT-proBNP from baseline to 8 months (absolute least-squares mean reduction, −303 pg/mL [95% CI, −457 to −150 pg/mL]; geometric mean ratio, 0.92 [95% CI, 0.88–0.96]). Dapagliflozin reduced the risk of worsening HF or cardiovascular death, irrespective of baseline NT-proBNP quartile; the hazard ratio for dapagliflozin versus placebo, from lowest to highest quartile was 0.43 (95% CI, 0.27–0.67), 0.77 (0.56–1.04), 0.78 (0.60–1.01), and 0.78 (0.64–0.95); P for interaction=0.09. Consistent benefits were observed for all-cause mortality. Compared with placebo, dapagliflozin increased the proportion of patients with a meaningful improvement (≥5 points) in Kansas City Cardiomyopathy Questionnaire total symptom score ( P for interaction=0.99) and decreased the proportion with a deterioration ≥5 points ( P for interaction=0.87) across baseline NT-proBNP quartiles. Conclusions: In patients with HFrEF, dapagliflozin reduced NT-proBNP by 300 pg/mL after 8 months of treatment compared with placebo. In addition, dapagliflozin reduced the risk of worsening HF and death, and improved symptoms, across the spectrum of baseline NT-proBNP levels included in DAPA-HF. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03036124.

Background. Mild elevation of serum amino-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is associated with myocardial dysfunction. A significantly lower Smith–Madigan inotropic index (SMII) has been shown to accurately represent cardiac contractility among heart failure subjects. We aim to monitor the effect of fluid resuscitation on cardiac function among paediatric patients by measuring serum NT-pro-BNP and SMII. Methods. This is an observational study on 70 paediatric shock patients. NT-pro-BNP and noninvasive bedside haemodynamic monitoring were done by using an ultrasonic cardiac output monitor (USCOM, USCOM, Sydney, Australia). The presence of cardiac diseases was excluded. SMII was obtained from the USCOM. An increase in the stroke volume index (SVI) of ≥15% indicates fluid responders. Measurements were taken before and after fluid loading. Results. Preloading NT-pro-BNP and SMII category were significantly different between the fluid responsiveness group, p = 0.001 and p = 0.004 , respectively. Higher median NT-pro-BNP (preloading NT-pro-BNP of 1175.00 (254.50–9965.00) ng/mL vs. 196.00 (65.00–509.00) ng/mL, p = 0.002 ) was associated with fluid nonresponders (subjects >12 months old). Preloading NT-pro-BNP p = 0.003 ), 82.1% sensitivity, and 68.7% specificity for subjects >12 years old. Delta NT-pro-BNP in fluid responders (15.00 (−16.00–950.00) ng/mL) did not differ from fluid nonresponders (505.00 (−797.00–1600.00) ng/mL), p = 0.456 . Postloading SMII >1.25 W·m−2 was associated with fluid responders (AUC: 0.683 (0.553–0.813), p = 0.011), 61.9% sensitivity, and 66.7% specificity, but not preloading SMII. Fluid responders had a higher mean postloading SMII compared to nonresponders (1.36 ± 0.38 vs. 1.10 ± 0.34, p = 0.006 ). Conclusion. Higher NT-pro-BNP and lower SMII in the absence of cardiac diseases were associated with poor response to fluid loading. The SMII is affected by low preload conditions.

Background Heart failure (HF) is a known risk factor for ischemic stroke, but data regarding ischemic stroke during hospitalization for acute decompensated HF (ADHF) are limited. Methods and Results We analyzed the data from a multicenter registry (Kyoto Congestive Heart Failure [KCHF] Registry) that enrolled 4056 consecutive patients with ADHF in Japan (mean age, 78 years; men, 2238 patients [55%]; acute coronary syndrome [ACS], 239 patients [5.9%]). We investigated the incidence and predictors of ischemic stroke during hospitalization for ADHF. During the hospitalization, 63 patients (1.6%) developed ischemic stroke. The median interval from admission to the onset of ischemic stroke was 7 [interquartile range: 2–14] days, and the most common underlying cause was cardioembolism (64%). Men (OR, 1.87; 95%CI, 1.11–3.24), ACS (OR, 2.31; 95%CI, 1.01–4.93), absence of prior HF hospitalization (OR, 2.21; 95%CI, 1.24–4.21), and high B‐type natriuretic peptide (BNP)/N‐terminal proBNP (NT‐proBNP) levels (above the median) at admission (OR, 3.15; 95%CI, 1.84–5.60) were independently associated with ischemic stroke. In patients without ACS, the independent risk factors for ischemic stroke were fully consistent with those in the main analysis. Higher quartiles of BNP/NT‐proBNP levels were significantly associated with higher incidence of ischemic stroke ( P for trend, Conclusions During hospitalization for ADHF, 1.6% of the patients developed ischemic stroke. Men, ACS, absence of prior HF hospitalization, and high BNP/NT‐proBNP levels at admission were independently associated with ischemic stroke.

The aim of the study was to determine the futility of NT-pro BNP level analysis during dosed physical exercise for diagnosing decompensated HF in the postinfarction period and the possibility to determine the HF functional class. Materials and methods. 160 patients with previous MI were examined, patients’ average age was (56.67±5.72) years. The patients were randomized in 2 groups dependently on the presence of the signs of II А-B according to V. Kh. Vasylenko and M. D. Strazhesko classification and FC III-IV (according to NYHA) decompensated chronic HF. Group I consisted of 120 patients with Q-QS and non-Q MI; group II (the control one) had 40 patients with MI without signs of decompensated HF; 20 healthy people made up a norm group. Results. Signs of coronary insufficiency such as dizziness and signs of poor peripheral perfusion (cyanosis/paleness) occurred in 104 (86.7 %) and 79 (65.8 %) cases that differ from the same values in the second group 4 (10.0 %) and 14 (35.0 %) respectively. 88 (73.3 %) patients with the signs of decompensated HF felt general weakness, fatigue, and expressed a request to stop the test. The HR in the postinfarction patients with the signs of decompensated HF was before the exercise (88.2±3.18) bpm (p≤0.05); in the patients with past MI without the signs of decompensated HF, it was (75.32±3.41) bpm (p≤0.05); and in the practically healthy people, it was (77.73±3.02) bpm. We found out a reverse moderate correlation between the distances that had been covered by a patient during the 6MWT NT-proBNP level in blood serum of examined patients. Conclusions. Inadequate response to dosed physical exercises and increased immunological parameters as quantitative HF markers could be useful not only for diagnostics, but also for the risk stratification for decompensated HF that had occurred in patients on different rehabilitation stages after an acute MI.

Background: In acute heart failure (AHF), elevated carbohydrate antigen 125 (CA125) and N-terminal pro-B-type natriuretic peptide (NTproBNP) have shown to correlate with adverse events. We sought to quantify their prognostic usefulness in predicting the 6-month combined endpoint of death/heart failure readmission.Methods: The study includes 352 patients admitted for AHF. The primary endpoint was 6-month combined endpoint of death/AHF rehospitalization. CA125 and NTproBNP were dichotomized according to the best cut-offs to predict 6-month primary endpoint. By multivariate Cox regression analysis, the independent association of CA125 and NTproBNP with the primary endpoint was assessed, and their incremental prognostic utility evaluated by net reclassification improvement (NRI) and integrated discrimination improvement (IDI) index. Results: A total of 47 (13.4%) deaths and 113 (32.1%) AHF rehospitalizations were identified at 6-month follow-up. The subjects with CA125≥39.7 U/ml and NTproBNP≥3900 pg/ml had significantly higher cumulative event rates (56.1% vs. 33.3% and 53.3% vs. 33.8%, both PConclusions: Elevated CA125 and NTproBNP predicted adverse outcomes in AHF patients. CA125 added prognostic value to NTproBNP, and thus, their combination conferred greater predictive capacity.

BACKGROUND Clinical findings associated with N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement in dogs and cats in primary practice, and their relevance to published measurement indications, have not been described. METHODS Using electronic health record data collected by the Small Animal Veterinary Surveillance Network, appointments in which NT-proBNP was measured were identified using keyword-based text filtering. For these appointments, clinical findings were manually identified from each patient's clinical narrative (CN) and their frequencies described. RESULTS CNs of 3510 appointments (357 dogs and 257 cats) from 99practices were evaluated. The most frequently recorded clinical findings in dogs were: heart murmur (n = 147, 41.2% (95% confidence interval (CI) = 36.1%-46.3%), coughing (n = 83, 23.2% (95% CI = 18.8%-27.6%)) and panting (n = 58, 16.2% (95% CI = 12.4%-20.0%)) and in cats: heart murmur (n = 143, 55.6% (95% CI = 49.5%-61.7%)), suspected thromboembolism (n = 88, 34.2% (95% CI = 28.4%-40.0%)) and weight loss (n = 53, 20.6% (95% CI = 15.7%-25.5%)). Dyspnoea and tachypnoea were infrequently reported in dogs (n = 29, 8.1% (95% CI = 5.3%-10.9%) and n = 21, 5.9% (95% CI = 3.5%-8.3%), respectively) and cats (n = 26, 10.1% (95% CI = 6.4%-13.8%) and n = 36, 14.0% (95% CI = 9.8%-18.2%), respectively). CONCLUSION Clinical findings referable to cardiac disease were recorded contemporaneously with NT-proBNP measurement and suggested both published and other indications (coughing (in dogs and cats), and serial measurements and thromboembolism (in cats)) for testing.

Hemodynamically significant patent ductus arteriosus (hsPDA) in premature newborns is associated with a risk of PDA-related morbidities. Classification into risk groups may have a clinical utility in cases of suspected hsPDA to decrease the need for echocardiograms and unnecessary treatment. This prospective observational study included 99 premature newborns with extremely low body weight, who had an echocardiogram performed within the first three days of life. Discriminant analysis was utilized to find the best combination of prognostic factors for evaluation of hsPDA. We used binary logistic regression analysis to predict the relationship between parameters and hsPDA. The cohort’s mean and standard deviation gestational age was 27.6 ± 2.55 weeks, the mean birth weight was 1015 ± 274 g. Forty-six (46.4%) infants had a PDA with a mean diameter of 2.78 mm. Median NT-pro-BNP levels were 17,600 pg/mL for infants with a PDA and 2773 pg/mL in the non-hsPDA group. The combination of prognostic factors of hsPDA in newborns of extremely low body weight on the third day of life was determined: NT-pro-BNP, Apgar score, Silverman–Anderson score (Se = 82%, Sp = 88%). A cut-off value of NT-pro-BNP of more than 8500 pg/mL can predict hsPDA (Se = 84%, Sp = 86%).

Introduction: The adverse prognosis of heart failure (HF) correlates with both N-terminal pro-B-type natriuretic peptide (NT-proBNP) and ferritin. The contribution of an underlying inflammatory process in the pathogenesis of HF is not only evidenced by increased ferritin (acute phase reactant), but also a reduced haemoglobin (Hb) due to cytokine-mediated bone marrow suppression. However, it remains unknown if there is a linear relationship between NT-pro BNP with ferritin and Hb levels. Objective: To determine an association between very elevated levels of NT-proBNP (>10,000pg/ ml) with Hb and ferritin in patients with HF. Methods: A retrospective, cross-sectional study to evaluate levels of ferritin and Hb among patients with very high NT-proBNP levels (>10,000pg/ml) treated at a district hospital serving a population of 500,000 people. Inclusion criteria: in-patient between October to December 2020, diagnosis of HF, NT-proBNP level >10,000 pg/ml, measured haemoglobin and ferritin level within 7 days of NT-proBNP measurement. Results: Forty-five patients met all of the inclusion criteria. Mean age 81 years ± 12 years. There was a positive correlation between NT- proBNP with ferritin and a negative correlation between NT-proBNP and Hb. With NT-proBNP on the x-axis and Hb on the y-axis, the trend line equated y = -0.0003x + 124.88. With NT-proBNP on the x-axis and ferritin on the y-axis, the trend line equated y = 0.0043x + 311.6. Conclusion: With rising levels of NT-proBNP, Hb levels decrease and ferritin levels increase in a linear manner, simultaneously. Larger studies are required to confirm this observation and to investigate the clinical implications of these findings.

Background Pulmonary hypertension (PH) is one of the common complications in chronic obstructive pulmonary disease (COPD). The study aimed to evaluate the predicting ability of N-terminal pro brain natriuretic peptide (NT-pro BNP) in patients with AECOPD-PH and its relationship with the severity of PH. Methods A large retrospective case-controlled study (n = 1072) was performed in the First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2020, and patients were divided into stable COPD (n = 178), AECOPD (n = 688) and AECOPD-PH group (n = 206). Different statistical models were used to screen for reliable and stable biomarkers. Results In unadjusted analysis and PSM (model 1, 2, 3), red cell distribution width (RDW), total bilirubin (TBIL), and NT-pro BNP were higher in patients with AECOPD-PH than those in AECOPD group. Logistic regression analysis showed, when the range of NT-proBNP was 271–1165 pg/mL (OR: 0.293; 95%CI: 0.184–0.467; P 1165 pg/mL (OR: 0.559; 95%CI: 0.338–0.926; P = 0.024), the morbidity risk of PH in AECOPD patients was increased, so did TBIL. In receiver operating characteristic (ROC) curves, at the cut-off value of NT-proBNP was 175.14 pg/mL, AUC was 0.651 (P rs = 0.299, P = 0.001) and its relative relevance with other biomarkers (RDW was 0.359 and TBIL was 0.238, P Conclusions Our findings suggest that NT-proBNP has a diagnostic efficacy in AECOPD-PH and NT-proBNP has a weak correlation with severity of PH with AECOPD.

Background: Galectin-3 (Gal-3) is considered both a profibrotic biomarker in Heart Failure with preserved Ejection Fraction (HFpEF) and a biomarker of atrial remodeling in Atrial Fibrillation (AF). The Left Atrial Volume Index (LAVI) is an echocardiographic parameter considered an index of left atrial remodeling. Aim of this study was to analyse the relation of Gal-3 levels with both LAVI and N-Terminal Pro B-Type Natriuretic Peptide (NT-proBNP) in patients with HFpEF and Persistent AF (HFpEF-PAF). Methods: Serum Gal-3 and NT-proBNP, along with LAVI were measured. A comparison of such parameters between 49 patients with HFpEF-PAF and 53 patients with HFpEF and sinus rhythm (HEpEF-SR) was made. Results: Galectin-3, NT-proBNP and LAVI were significantly higher in patients with HFpEF-PAF compared to HFpEF-SR (23±7 ng/mL vs 19.5±8.5 ng/mL, p=0.027; 3,406.8±2,321.9 pg/mL vs 1,459.6±1,372 pg/mL, p17.8 ng/mL and HFpEF-PAF (p=0.002). Finally, a multivariate logistic regression analysis adjusted for age, sex and traditional clinical AF risk factors showed that Gal-3 >17,8 ng/mL (OR 3.862, 95% CI 1.416 to 10.532, p=0.008) was an independent predictor of PAF. Conclusions: In patients with HFpEF-PAF Gal-3 was higher and related with both NT-proBNP and LAVI. The latter correlation may be relevant because LAVI is considered an index of left atrial remodeling. Moreover, higher levels of Gal-3>17,8 ng/mL were an independent predictor of PAF.

Background: The American Heart Association (2016) stated that at the age of forty the risk of developing heart failure is one in five. Medication is based on clinical signs and symptoms that are often late. Early cardiac markers are required to guide therapy. This study compared the difference between ST2 and NT-ProBNP concentrations before and after ACE inhibitors (ACE-I) in NYHA III-IV heart failure patients. Method: This was a randomized prospective observational study without controls. The respondents were males or females, 21-75 y.o in NYHA III-IV heart failure patients. Twenty-five respondents were appropriate to inclusion criteria. The ST2 was measured by Quantikine®ST2/IL-33R quantitative sandwich ELISA immunoassay while NT-proBNP was measured by Immulite Turbo® 1000. Result: Majority of respondents were males (60%) and had comorbidities(60,7%), consisting of NYHA Class III(36%) and IV(64%). Coronary artery disease and valvular heart disease (40%,36% respectively). Length of stay was 6.4±3.4days. The concentration difference of ST2 and NT-proBNP before and after ACE-I were both significant, however, NT-proBNP was more significant (p=0,001 vs p=0,023). NYHA at admission influenced ST2 difference but not NT-proBNP. NT-proBNP concentration correlated to length of stay while ST2 was not. ST2 had negative correlation with age, no correlation to GFR and weight. NT-proBNP was correlated to weight, negatively correlated to GFR, not correlated to age. ACE-I subtypes difference did not affect the study result. Conclusion: NT-proBNP was a better heart failure cardiac marker than ST2 due to its ability in diagnosis, prognosis and showing more significant difference after ACE-I administration.

Objective: The aim of this study is to determine the correlation between the symptom of heart failure and basic investigations; N-Terminal-Pro-B Type Natriuretic Peptide (NT-proBNP) and cardiothoracic (CT) ratio from chest radiograph in pediatric heart disease. Methods: One-hundred-eighty children (aged 1-15 years) with underlying heart disease were enrolled in this prospective cross-sectional study. The heart failures were categorized based on the Ross classification into 2 groups, non-heart failure (Ross classification I) and heart failure (Ross classification II-IV). The NT‐proBNP level was determined and chest radiograph was done in posteroanterior upright position for CT ratio. Results: The mean NT-proBNP level was 223.1 pg/ml ( + 180.3) and a mean CT ratio was 53.6% ( + 5.6) in the non-heart failure group. The mean NT-proBNP level was 1,054 pg/ml ( + 1,840.3) and a mean CT ratio was 58.6% ( + 6.1) in heart failure group. There was a significantly positive correlation between heart failure symptoms and the level of NT-proBNP and CT ratio. In this study, the cut-off value of NT-proBNP for heart failure was more than 400 pg/ml (OR 6.97, ROC 0.694, sensitivity 52.6%, specificity 86.3%) and CT ratio more than 55% (OR 3.57, ROC 0.654, sensitivity 68%, specificity 62.8%). Conclusion: In pediatric heart diseases, there are strong positive correlations between heart failure with both NT-proBNP and CT ratio. These correlations help in the diagnosis of heart failure. NT-proBNP level more than 400 pg/ml and CT ratio more than 55% are indicative of heart failure in our population. Both investigations are inexpensive, readily available and do not require specialist experts.

Using biomarkers to predict mortality in patients with sepsis is important because these patients frequently have high mortality rates and unsatisfactory outcomes. The performance of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-reactive protein (CRP) to predict clinical outcomes in elderly sepsis patients is unimpressive. We aimed to assess the prognostic value of NT-pro-BNP, CRP and the combination of both in selected medical ICU sepsis patients more than 75 years old.In total, 245 consecutive patients were screened for eligibility and followed during their ICU stays. We collected the patients' baseline characteristics, including their Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and NT-pro-BNP and CRP levels. The primary outcome was ICU mortality. Potential predictors were analyzed for their possible associations with the outcome. We also evaluated the ability of NT-pro-BNP and CRP levels combined with the APACHE II score to predict ICU mortality by calculating the C-index and net reclassification improvement (NRI).Univariate regression revealed that CRP, NT-pro-BNP, APACHE II score, lactic acid level, NEU count(neutrophil count)and HCT level independently predicted ICU mortality (all P 0.01). The C-index for the prediction of ICU mortality by the APACHE II score (0.847 ± 0.029; P 0.001) was greater than that for NT-pro-BNP (0.673 ± 0.039; P 0.01) or CRP (0.626 ± 0.039; P 0.01) (all P 0.01). Compared with the APACHE II score (0.847 ± 0.029; P 0.001), the combination of CRP (0.849 ± 0.029; P 0.01) or NT-pro-BNP (0.853 ± 0.028; P 0.01) or both (0.853 ± 0.030; P 0.01) with the APACHE II score did not significantly increase the C-index for predicting ICU mortality (all P 0.05). However, the addition of NT-pro-BNP to the APACHE II score gave an NRI of 8.6% (P = 0.000), the addition of CRP to the APACHE II score provided an NRI of 11.34% (P = 0.012), and the addition of both markers to the APACHE II score yielded an NRI of 29.0% (P = 0.000). In the MOF subgroup (N = 118), CRP (OR = 2.62, P 0.05) but not NT-pro-BNP (OR = 1.73, p 0.05) independently predicted ICU mortality, and the addition of CRP to the APACHE II score obviously increased its predictive ability (NRI = 13.88%, P = 0.000). In the non-MOF group (N = 127), neither CRP (OR = 5.447, P = 0.078) nor NT-pro-BNP (OR = 2.239, P = 0.016) was an independent predictor of ICU mortality.In sepsis patients older than 75 years, NT-pro-BNP and CRP can serve as independent predictors of mortality, and the addition of NT-pro-BNP or CRP or both to the APACHE II score significantly improves the ability to predict ICU mortality. CRP appears to be useful for predicting ICU outcomes in elderly sepsis patients with multiple-organ failure.

Purpose: Elevation of high-sensitivity cardiac troponin T (hs-cTnT) is associated with an increased risk of cardiovascular disease (CVD). This study determined whether hs-cTnT was detectabl...

Bei Patienten mit akuter Dyspnoe konnen Biomarker helfen zwischen akuter Herzinsuffizienz und Luftnot nichtkardialer Genese zu unterscheiden. Hierbei sind vor allem die natriuretischen Peptide von groser praktischer Bedeutung. Sie sollten im Rahmen der Aufnahme bei allen Patienten mit akuter Luftnot bestimmt werden. Einen hohen Stellenwert hat insbesondere deren hoher negativer pradiktiver Wert, der den weitgehenden Ausschluss einer Herzinsuffizienz bei normwertigen natriuretischen Peptiden erlaubt. Zur Verfugung stehen Assays fur das natriuretische Peptid vom B‑Typ (BNP), das N‑terminale pro-natriuretische Peptid vom B‑Typ (NT-proBNP) und das mittregionale pro-atriale natriuretische Peptid (MR-proANP) mit unterschiedlichen Grenzwerten. Bei Patienten, die mit einem Angiotensinrezeptor-Neprilysin-Inhibitor behandelt werden, muss NT-proBNP (oder MR-proANP) zur Beurteilung verwendet werden, da BNP durch die Medikamentenwirkung gesteigert wird und daher keine adaquate Aussage zur Krankheitsschwere zulasst. Neben der gut etablierten diagnostischen Bedeutung bei der akuten Herzinsuffizienz konnen die natriuretischen Peptide auch eine Rolle bei der Beurteilung der Krankheitsschwere und bei der Prognoseabschatzung spielen. Neben den natriuretischen Peptiden existieren zahlreiche weitere Biomarker, die verschiedene pathophysiologische Vorgange der Herzinsuffizienz widerspiegeln. Ob diese Biomarker den Sprung in die klinische Routine schaffen, bleibt abzuwarten.

Objective This study was performed to investigate the relationship between the serum cystatin C (Cys C) level and acute coronary syndrome (ACS) in patients of advanced age. Methods The study included 184 patients with ACS and 46 healthy control subjects. Statistical analysis was performed using SPSS version 14.0 (SPSS Inc., Chicago, IL, USA). Results The serum Cys C level was significantly higher in patients with than without ACS (1.24 ± 0.30 vs. 1.42 ± 0.46 mg/L, respectively). Patients with more stenotic coronary arteries were significantly more likely to have higher median serum Cys C and creatinine levels and a lower estimated glomerular filtration rate. The multivariate logistic regression analysis demonstrated that the serum Cys C level was independently associated with the presence of ACS and the quantity of stenotic coronary arteries after adjustment for confounding factors. Additionally, the serum Cys C level was positively correlated with age, the creatinine level, and the N-terminal pro-B-type natriuretic peptide level in all patients but was negatively correlated with the estimated glomerular filtration rate. Conclusion A high serum Cys C level was independently associated with ACS and the quantity of stenotic coronary arteries in patients of advanced age regardless of renal function.