RESUMO
BACKGROUND: Natriuretic peptide testing is guideline recommended as an aid to the diagnosis of heart failure (HF). We sought to evaluate the performance of the ADVIA Centaur (Siemens Healthcare Diagnostics, Tarrytown, NY) NT-proBNPII assay (PBNPII) in emergency department (ED) dyspneic patients. METHODS: Eligible patients presented to the ED with dyspnea, with their gold standard diagnosis determined by up to 3 cardiologists blinded to the PBNPII results. Patients were stratified into 3 groups based on PBNPII resultsa rule out group of NT-proBNP<300 pg/mL, an age-specific rule in group using cutoffs of 450, 900, and 1800 pg/mL, for <50, 50-75, and > 75 years respectively, and an intermediate cohort for results between the rule out and rule in groups. RESULTS: Of 3128 eligible patients, 1148 (36.7 %) were adjudicated as acute heart failure (AHF). The gold standard AHF diagnosis rate was 3.7, 24.3, and 67.2 % for patients with NTproBNPII in the negative, indeterminate, and positive groups, respectively. Overall likelihood ratios (LR) were 0.07 (95 % CI: 0.05,0.09), 0.55 (0.45,0.67), and 3.53 (3.26,3.83) for the same groups, respectively. Individual LR+for age dependent cutoffs were 5.01 (4.25,5.91), 3.71 (3.25,4.24), and 2.38 (2.10,2.69), respectively. NTproBNPII increased with increasing severity of HF when stratified by NYHA classification. CONCLUSIONS: The ADVIA Centaur PBNPII assay demonstrates acceptable clinical performance using the recommended single rule out and age dependent rule in cutoffs for an AHF diagnosis in dyspneic ED patients.
Assuntos
Serviço Hospitalar de Emergência , Insuficiência Cardíaca , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Humanos , Peptídeo Natriurético Encefálico/sangue , Idoso , Feminino , Masculino , Pessoa de Meia-Idade , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/sangue , Fragmentos de Peptídeos/sangue , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: In pediatric cardiology, the fact that some new biomarkers have assay-specific normal values has to be considered for correct clinical decisions. The current study aimed to provide age-adjusted normative values for NT-proBNP and Galectin-3 using the Abbott immunoassay system from a prospective French pediatric cohort sera collection and to validate our data for NT-proBNP on a second retrospective cohort. METHODS: We analyzed 283 consecutive samples for NT-proBNP and 140 samples for Galectin-3 collected from apparently healthy children (0-18 years) with outpatient treatment at our institution (Hôpital Necker-Enfants malades, Paris, France) during 24 months. RESULTS: For NT-proBNP and Galectin-3, we establish four age partitions, respectively two (<2 years / >2 years) and establish upper reference values and their 90 % CI for each biomarker (Galectin-3 (ng/mL): 56 [44-70] / 26 [23-29]). We evaluated the diagnostic performance of our upper reference values of NT-proBNP on a retrospective cohort (n = 428) with positive predictive value of 0.92. CONCLUSIONS: Using Abbott immunoassay system, we report age-specific reference values for NT-proBNP and for the first time for Galectin-3 in a healthy French pediatric cohort. These data call for larger cohort studies to define more robustly percentiles and diagnostic performance for NT-proBNP.
Assuntos
Galectina 3 , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Humanos , Criança , Fragmentos de Peptídeos/sangue , Adolescente , Pré-Escolar , Lactente , França , Valores de Referência , Peptídeo Natriurético Encefálico/sangue , Feminino , Galectina 3/sangue , Estudos de Coortes , Masculino , Recém-Nascido , Imunoensaio/normas , Biomarcadores/sangue , Estudos Retrospectivos , Galectinas/sangueRESUMO
BACKGROUND: Acute dyspnoea is common in acute care settings. However, identifying the origin of dyspnoea in the emergency department (ED) is often challenging. We aimed to investigate whether our artificial intelligence (AI)-powered ECG analysis reliably distinguishes between the causes of dyspnoea and evaluate its potential as a clinical triage tool for comparing conventional heart failure diagnostic processes using natriuretic peptides. METHODS: A retrospective analysis was conducted using an AI-based ECG algorithm on patients ≥18 years old presenting with dyspnoea at the ED from February 2006 to September 2023. Patients were categorised into cardiac or pulmonary origin groups based on initial admission. The performance of an AI-ECG using a transformer neural network algorithm was assessed to analyse standard 12-lead ECGs for accuracy, sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Additionally, we compared the diagnostic efficacy of AI-ECG models with N-terminal probrain natriuretic peptide (NT-proBNP) levels to identify cardiac origins. RESULTS: Among the 3105 patients included in the study, 1197 had cardiac-origin dyspnoea. The AI-ECG model demonstrated an AUC of 0.938 and 88.1% accuracy for cardiac-origin dyspnoea. The sensitivity, specificity and positive and negative predictive values were 93.0%, 79.5%, 89.0% and 86.4%, respectively. The F1 score was 0.828. AI-ECG demonstrated superior diagnostic performance in identifying cardiac-origin dyspnoea compared with NT-proBNP. True cardiac origin was confirmed in 96 patients in a sensitivity analysis of 129 patients with a high probability of cardiac origin initially misdiagnosed as pulmonary origin predicted by AI-ECG. CONCLUSIONS: AI-ECG demonstrated superior diagnostic accuracy over NT-proBNP and showed promise as a clinical triage tool. It is a potentially valuable tool for identifying the origin of dyspnoea in emergency settings and supporting decision-making.
Assuntos
Inteligência Artificial , Dispneia , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Estudos Retrospectivos , Masculino , Dispneia/etiologia , Dispneia/diagnóstico , Dispneia/fisiopatologia , Feminino , Eletrocardiografia/métodos , Diagnóstico Diferencial , Idoso , Pessoa de Meia-Idade , Doença Aguda , Pneumopatias/diagnóstico , Pneumopatias/sangue , Peptídeo Natriurético Encefálico/sangue , Biomarcadores/sangue , Cardiopatias/diagnóstico , Cardiopatias/sangue , Cardiopatias/fisiopatologia , Triagem/métodos , Valor Preditivo dos Testes , Fragmentos de Peptídeos/sangue , Reprodutibilidade dos TestesRESUMO
OBJECTIVES: MicroRNAs are considered as a class of potential biomarkers for HF. This study aimed to retrospectively evaluate the diagnostic and prognostic value of microRNA423-5p in patients with HF. METHODS: The observational group comprised 98 patients diagnosed with HF due to coronary atherosclerotic heart disease (n = 45), hypertension (n = 26), or cardiac valve insufficiency (n = 27). Conversely, the control group consisted of 30 healthy volunteers without any history of HF. These patients were further classified into heart function class II (n = 33), class III (n = 32), and class IV (n = 33) according to the NYHA classification. Of these patients, 33 were diagnosed with HF with mid-range ejection fraction (HFmrEF) and the remaining 65 with HF with reduced ejection fraction (HFrEF). The diagnostic and prognostic significance of microRNA423-5p in patients with HF was assessed through laboratory parameter assessments (microRNA423-5p and B-type natriuretic peptide test, BNP), cardiac ultrasound evaluations (left ventricular ejection fraction, LVEF), and subsequent follow-up assessments. RESULTS: In this study, we found that patients with HF exhibited notably elevated levels of microRNA423-5p and BNP, as well as significantly lower LVEF values. A significant positive correlation between microRNA423-5p and BNP indicators was validated. In addition, our study also revealed an elevation in the level of microRNA423-5p correlating with the progression of the HF. The combined evaluation of LEVF, BNP, and microRNA423-5p demonstrated superior diagnostic efficacy in comparison to the solitary use of BNP. CONCLUSIONS: Elevated levels of microRNA423-5p in the serum of patients with HF suggest its potential utility as a novel biomarker for both the diagnosis and prognosis of this condition.
Assuntos
Biomarcadores , Insuficiência Cardíaca , MicroRNAs , Humanos , Masculino , MicroRNAs/sangue , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Prognóstico , Pessoa de Meia-Idade , Estudos Retrospectivos , Biomarcadores/sangue , Idoso , Volume Sistólico/fisiologia , Peptídeo Natriurético Encefálico/sangueRESUMO
BACKGROUND: Plasma growth differentiation factor 15 (GDF15) and N-terminal proB-type natriuretic peptide (NT-proBNP) are cardiovascular biomarkers that associate with a range of diseases. Epigenetic scores (EpiScores) for GDF15 and NT-proBNP may provide new routes for risk stratification. RESULTS: In the Generation Scotland cohort (N ≥ 16,963), GDF15 levels were associated with incident dementia, ischaemic stroke and type 2 diabetes, whereas NT-proBNP levels were associated with incident ischaemic heart disease, ischaemic stroke and type 2 diabetes (all PFDR < 0.05). Bayesian epigenome-wide association studies (EWAS) identified 12 and 4 DNA methylation (DNAm) CpG sites associated (Posterior Inclusion Probability [PIP] > 95%) with levels of GDF15 and NT-proBNP, respectively. EpiScores for GDF15 and NT-proBNP were trained in a subset of the population. The GDF15 EpiScore replicated protein associations with incident dementia, type 2 diabetes and ischaemic stroke in the Generation Scotland test set (hazard ratios (HR) range 1.36-1.41, PFDR < 0.05). The EpiScore for NT-proBNP replicated the protein association with type 2 diabetes, but failed to replicate an association with ischaemic stroke. EpiScores explained comparable variance in protein levels across both the Generation Scotland test set and the external LBC1936 test cohort (R2 range of 5.7-12.2%). In LBC1936, both EpiScores were associated with indicators of poorer brain health. Neither EpiScore was associated with incident dementia in the LBC1936 population. CONCLUSIONS: EpiScores for serum levels of GDF15 and Nt-proBNP associate with body and brain health traits. These EpiScores are provided as potential tools for disease risk stratification.
Assuntos
Biomarcadores , Metilação de DNA , Diabetes Mellitus Tipo 2 , Fator 15 de Diferenciação de Crescimento , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Humanos , Fator 15 de Diferenciação de Crescimento/sangue , Fator 15 de Diferenciação de Crescimento/genética , Peptídeo Natriurético Encefálico/sangue , Peptídeo Natriurético Encefálico/genética , Fragmentos de Peptídeos/sangue , Fragmentos de Peptídeos/genética , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/genética , Metilação de DNA/genética , Biomarcadores/sangue , Escócia , Demência/sangue , Demência/genética , Epigênese Genética , AVC Isquêmico/sangue , AVC Isquêmico/genética , Teorema de Bayes , Estudos de CoortesRESUMO
Cardiovascular-kidney-metabolic health reflects the interactions between metabolic risk factors, chronic kidney disease, and the cardiovascular system. A growing body of literature suggests that metabolic syndrome (MetS) in individuals of normal weight is associated with a high prevalence of cardiovascular diseases and an increased mortality. The aim of this study was to establish a non-invasive preclinical model of MetS in support of future research focusing on the effects of novel antidiabetic therapies beyond glucose reduction, independent of obesity. Eighteen healthy adult Beagle dogs were fed an isocaloric Western diet (WD) for ten weeks. Biospecimens were collected at baseline (BAS1) and after ten weeks of WD feeding (BAS2) for measurement of blood pressure (BP), serum chemistry, lipoprotein profiling, blood glucose, glucagon, insulin secretion, NT-proBNP, angiotensins, oxidative stress biomarkers, serum, urine, and fecal metabolomics. Differences between BAS1 and BAS2 were analyzed using non-parametric Wilcoxon signed-rank testing. The isocaloric WD model induced significant variations in several markers of MetS, including elevated BP, increased glucose concentrations, and reduced HDL-cholesterol. It also caused an increase in circulating NT-proBNP levels, a decrease in serum bicarbonate, and significant changes in general metabolism, lipids, and biogenic amines. Short-term, isocaloric feeding with a WD in dogs replicated key biological features of MetS while also causing low-grade metabolic acidosis and elevating natriuretic peptides. These findings support the use of the WD canine model for studying the metabolic effects of new antidiabetic therapies independent of obesity.
Assuntos
Modelos Animais de Doenças , Hipoglicemiantes , Síndrome Metabólica , Obesidade , Animais , Cães , Síndrome Metabólica/tratamento farmacológico , Síndrome Metabólica/metabolismo , Obesidade/metabolismo , Obesidade/tratamento farmacológico , Hipoglicemiantes/farmacologia , Hipoglicemiantes/uso terapêutico , Masculino , Glicemia/metabolismo , Biomarcadores/sangue , Pressão Sanguínea/efeitos dos fármacos , Peptídeo Natriurético Encefálico/sangue , Peptídeo Natriurético Encefálico/metabolismo , Estresse Oxidativo/efeitos dos fármacos , FemininoRESUMO
Metabolic comorbidities, such as obesity and diabetes, are associated with subclinical alterations in both cardiac structure/function and natriuretic peptides prior to the onset of heart failure (HF). Despite this, the exact metabolic pathways of cardiac dysfunction which precede HF are not well-defined. Among older individuals without HF in the Multi-Ethnic Study of Atherosclerosis (MESA), we evaluated the associations of 47 circulating metabolites measured by 1H-NMR with echocardiographic measures of cardiac structure and function. We then evaluated associations of significant metabolites with circulating N-terminal pro-B-type natriuretic peptide (NT-proBNP). In a separate cohort, we evaluated differences between top metabolites in patients with HF with preserved ejection fraction (HFpEF) and comorbidity-matched controls. Genetic variants associated with top metabolites (mQTLs) were then related to echocardiographic measures and NT-proBNP. Among 3440 individuals with metabolic and echocardiographic data in MESA (62 ± 10 years, 52% female, 38% White), 10 metabolites broadly reflective of glucose and amino acid metabolism were associated with at least 1 measure of cardiac structure or function. Of these 10 metabolites, 4 (myo-inositol, glucose, dimethylsulfone, carnitine) were associated with higher NT-proBNP and 2 (d-mannose, acetone) were associated with lower NT-proBNP. In a separate cohort, patients with HFpEF had higher circulating myo-inositol levels compared with comorbidity-matched controls. Genetic analyses revealed that 1 of 6 known myo-inositol mQTLs conferred risk of higher NT-proBNP. In conclusion, metabolomic profiling identifies several novel metabolites associated with cardiac dysfunction in a cohort at high risk for HF, revealing pathways potentially relevant to future HF risk.
Assuntos
Insuficiência Cardíaca , Metabolômica , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Metabolômica/métodos , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/genética , Peptídeo Natriurético Encefálico/sangue , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/sangue , Volume Sistólico , Ecocardiografia , Metaboloma , Biomarcadores/sangue , Idoso de 80 Anos ou mais , Inositol/metabolismoRESUMO
BACKGROUND: Heart failure is one of the leading causes of mortality and hospitalization in cardiovascular patients. Guideline-directed medical treatment (GDMT) in the current era includes novel medications such as ARNI and SGLT2 inhibitors, as well as an approach to treatment based on clinical phenotypes. To assess prognostic factors for mortality and hospital readmissions plays a crucial role in patient care. OBJECTIVES: This study aimed to determine the rate of 90-day post-discharge events in patients having heart failure with reduced ejection fraction (HFrEF) and investigate the associated clinical factors. METHOD: A prospective study was conducted on 110 HFrEF patients at the cardiology department of Cho Ray Hospital. The 90-day events included all-cause mortality and rehospitalization due to heart failure. RESULTS: The rate of 90-day events was 45.6%. After multivariable Cox regression analysis, NT-proBNP level ≥ 1858 pg/mL was identified as an independent factor associated with the 90-day events. CONCLUSION: NT-proBNP cut-off ≥ 1858 pg/mL can be used for the prognosis of 90-day events in HFrEF.
Assuntos
Insuficiência Cardíaca , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Humanos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/tratamento farmacológico , Peptídeo Natriurético Encefálico/sangue , Masculino , Fragmentos de Peptídeos/sangue , Feminino , Prognóstico , Idoso , Pessoa de Meia-Idade , Estudos Prospectivos , Readmissão do Paciente/estatística & dados numéricos , Volume Sistólico , Biomarcadores/sangueRESUMO
In this study, we investigated the mechanism underlying electrocardiogram (ECG) alterations in a rabbit model of acute pulmonary thromboembolism (PTE). Twelve healthy adult New Zealand white rabbits were used, with eight in the experimental group (PTE group) and four in the control group. After developing the rabbit model of acute PTE, ECG and coronary angiography were performed. HE staining was conducted on the right and left ventricular tissues, and polymerase chain reaction (PCR) was used to determine brain natriuretic peptide (BNP), tumor necrosis factor-alpha (TNF-?), and Troponin I (TNI) mRNA expression in the myocardium. There were considerable changes in the ST segment of the ECG in the PTE group. Coronary angiography revealed the absence of spasm, stenosis, and occlusion. In the plasma of the PTE group, the levels of D-dimer, BNP, TNF-?, and TNI were significantly elevated, and these changes were statistically significant (P<0.05). PCR analysis of ventricular myocardial tissue indicated significantly higher levels of BNP, TNF-?, and TNI mRNA in the PTE group than in the control group. These differences were statistically significant (P<0.05). The ST-T variations on the ECG of rabbits with acute PTE correlate strongly with the temporary changes in right heart volume caused by acute PTE. Keywords: Animal model of pulmonary embolism, B-type natriuretic peptide, Electrocardiogram, Pulmonary thromboembolism, Troponin I, Tumor necrosis factor-alpha.
Assuntos
Modelos Animais de Doenças , Eletrocardiografia , Embolia Pulmonar , Animais , Coelhos , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/sangue , Masculino , Troponina I/sangue , Troponina I/metabolismo , Doença Aguda , Peptídeo Natriurético Encefálico/sangue , Fator de Necrose Tumoral alfa/sangue , Fator de Necrose Tumoral alfa/metabolismo , Fator de Necrose Tumoral alfa/genéticaRESUMO
The paper presents an analysis of the proteomic composition in relation to both the risk of thrombosis and changes in the state of cardiomyocytes associated with the risk of cardiac fibrosis and heart failure. We examined 12 practically healthy male volunteers exposed to head-down -6° tilt bed rest (HDBR) for 21 days. The revealed decrease in the level of stimulating growth factor 2 (ST2) on days 10 and 21 relative to the initial values (background; 5 days before HDBR) indicated a decrease in the myocardial load and cardiomyocyte extensibility. The level of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) increased on day 2, decreased on days 10 and 21 of HDBR relative to the background levels, and returned to baseline values after the recovery period (5 days after HDBR). The revealed changes in the level of NT-proBNP reflected the increase in circulating blood volume corresponding to HDBR duration and the role of the gravity component in increasing the functional load on the myocardium. Unchanged blood level of D-dimer at all points of the study indicates that there is no risk of thrombosis under the conditions of this study.
Assuntos
Repouso em Cama , Biomarcadores , Produtos de Degradação da Fibrina e do Fibrinogênio , Decúbito Inclinado com Rebaixamento da Cabeça , Voluntários Saudáveis , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Humanos , Peptídeo Natriurético Encefálico/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Masculino , Fragmentos de Peptídeos/sangue , Adulto , Biomarcadores/sangueRESUMO
BACKGROUND/AIM: The study aims to describe the role of diabetes in patients with heart failure. METHODS: In all, 1052 chronic heart failure patients were included in the FARmacology and NeuroHumoral Activation (FAR NHL) multicenter prospective registry. They had ejection fraction below 50% and were on stable medication for at least 1 month. RESULTS: More than one-third (38.9%) of the patients had diabetes mellitus (DM). Diabetic patients (N = 409) were older (median 67 vs. 64, p < 0.001), had higher body mass index (BMI) (30 vs. 28 kg/m2, p < 0.001), much more frequently had ischemic heart disease (71 vs. 47%, p < 0.001), hypertension (80 vs. 67%, p < 0.001), dyslipidemia (89 vs. 69%, p < 0.001), worse renal function (estimated glomerular filtration rate [eGFR] median 63 vs. 73 mL/min/1.73 m2, p < 0.001), and higher N-terminal pro-brain natriuretic peptide (NT-proBNP) (median 681 vs. 463 pg/mL, p = 0.003). All-cause death, left ventricle assist device implantation, and orthotopic heart transplantation were set as the combined primary end point, which was present in 15.5% (163 patients) within the 2-year follow-up. In the 2-year follow-up, 81.0% of patients with diabetes survived without a primary end point, while 85.4% of the patients without diabetes survived, the difference being on the verge of statistical significance (p = 0.089). DM is a statistically significant predictor of NT-proBNP value in univariate analysis, but it is not an independent predictor in a multivariate analysis. When the NT-proBNP level was high, the presence of DM did not influence the prognosis. CONCLUSION: The combination of diabetes and NT-proBNP levels may better stratify the prognosis of patients with chronic heart failure.
Assuntos
Diabetes Mellitus , Insuficiência Cardíaca , Peptídeo Natriurético Encefálico , Sistema de Registros , Humanos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Prognóstico , Doença Crônica , Diabetes Mellitus/sangue , Diabetes Mellitus/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Estudos Prospectivos , Fragmentos de Peptídeos/sangueRESUMO
Objective: The study investigates value of preoperative prognostic nutritional index (PNI) combined with N-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting postoperative acute kidney injury (AKI) in congenital heart disease (CHD) children. Methods: The clinical data of 108 children with congenital heart disease were retrospectively collected. According to whether AKI occurred 48 h after operation, they were divided into AKI group (n = 32) and non-AKI group (n = 76). The clinical data, preoperative PNI and NT-proBNP levels were compared between the two groups. Multivariate logistic regression analysis was used to analyze the influencing factors of AKI, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of preoperative PNI, NT-proBNP and their combination. Results: Multivariate logistic regression analysis showed that Scr, PNI and NT-proBNP were independent risk factors for postoperative AKI in children with congenital heart disease (P < 0.001). The results of ROC curve analysis showed that the area under the curve (AUC) of preoperative PNI, NT-proBNP and their combination in predicting postoperative AKI in children with congenital heart disease were 0.839, 0.738 and 0.907, respectively, and the AUC of their combination was the highest. Conclusion: The combined use of preoperative PNI as well as NT-proBNP holds significant value in predicting postoperative AKI in CHD children. Monitoring preoperative PNI and NT-proBNP levels may aid in clinically identifying the risk of postoperative AKI in CHD children, thereby improving their prognosis.
Assuntos
Injúria Renal Aguda , Cardiopatias Congênitas , Peptídeo Natriurético Encefálico , Avaliação Nutricional , Fragmentos de Peptídeos , Humanos , Peptídeo Natriurético Encefálico/sangue , Cardiopatias Congênitas/cirurgia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/sangue , Fragmentos de Peptídeos/sangue , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/sangue , Injúria Renal Aguda/epidemiologia , Feminino , Masculino , Estudos Retrospectivos , Prognóstico , Lactente , Pré-Escolar , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Biomarcadores/sangue , Curva ROC , Fatores de Risco , Criança , Valor Preditivo dos TestesRESUMO
BACKGROUND Chronic heart failure (CHF) is a complex clinical syndrome associated with frequent, recurrent, and long-term hospitalizations. This study from a single center in Lithuania aimed to evaluate outcomes in 87 elderly patients hospitalized with CHF. The methods used included comparing transthoracic impedance cardiography (ICG), amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, the six-minute walk test (6MWT), and dilatation of the right pulmonary artery on chest X-ray (dRPAcXR). MATERIAL AND METHODS The study sample consisted of 87 patients (49 men and 38 women). All subjects underwent 6MWT and ICG in addition to the standard CHF tests. The median duration of the follow-up was 23 months. Data about patient outcomes were gathered from the National Medical Record Database. RESULTS By multivariate Cox proportional analysis, thoracic fluid content (TFC) ≥41.1 1/kΩ (hazard ratio [HR] 32.354, 95% confidence interval [CI] 2.758-379.488), NT-proBNP ≥332.0 pmol/L (HR 4.739, 95% CI 1.656-13.559), 6-minute walk distance (6MWD) ≤203.5 m (HR 3.975, 95% CI 1.002-15.770), and dRPAcXR (HR 5.555, 95% CI 1.714-18.005) were associated with a poor prognosis in CHF patients (all P<0.05). The correlations between ICG and 6MWD and other non-invasive diagnostic tests examined in this study were weak to moderate. CONCLUSIONS TFC ≥41.1 1/kΩ, NT-proBNP ≥332.0 pmol/L, 6MWD ≤203.5 m, and dRPAcXR had a combined prognostic value in predicting cardiovascular death in patients with CHF. Therefore, these parameters may be of value in the assessment of the diagnosis and prognosis in this patient cohort.
Assuntos
Cardiografia de Impedância , Insuficiência Cardíaca , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Teste de Caminhada , Humanos , Feminino , Masculino , Peptídeo Natriurético Encefálico/sangue , Lituânia , Idoso , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/sangue , Prognóstico , Cardiografia de Impedância/métodos , Teste de Caminhada/métodos , Fragmentos de Peptídeos/sangue , Idoso de 80 Anos ou mais , Doença Crônica , Radiografia Torácica/métodos , Pessoa de Meia-Idade , Modelos de Riscos ProporcionaisRESUMO
BACKGROUND: Immigrants experience changes in cardiovascular risk factors and racial disparities in both cardiovascular health prevention and outcomes upon immigration. We aimed to examine cardiovascular risk factors and outcomes among Chinese American immigrants enrolled in the MESA (Multi-Ethnic Study of Atherosclerosis) cohort. METHODS AND RESULTS: We analyzed data from 746 Chinese American immigrants in the MESA study with a median follow-up period of 17.8 years. The mean age of the cohort was 62.3 years, with 52.7% being women. Kaplan-Meier curves and Cox proportional hazards models were used to assess the association of immigration history, geographic location, biomarkers, and cardiac imaging parameters with cardiovascular risk factors and cardiovascular outcomes. The Cox hazards models were adjusted for known family history of heart disease, education level, sex, diabetes, hypertension, age, and body mass index. Although immigration history categorized as earlier (<20 years) versus later (≥20 years) showed no association with cardiovascular outcomes, the duration of residence in the United States emerged as a strong predictor for an increased risk of cardiovascular disease death (hazard ratio 1.39 [95% CI, 1.07-1.8]; P=0.012). All-cause mortality differed significantly between the Chinese immigrants from Los Angeles and those from Chicago, with higher survival probability in Chicago (log-rank test, P=0.018). Furthermore, elevated levels of N-terminal pro-brain natriuretic peptide levels, left ventricular mass, and coronary artery calcium scores were associated with the risk of cardiovascular disease among Chinese immigrants. CONCLUSIONS: Within the MESA cohort, the duration of residence and geographic location were associated with the risk of cardiovascular disease outcomes among Chinese immigrants.
Assuntos
Asiático , Doenças Cardiovasculares , Emigrantes e Imigrantes , Fatores de Risco de Doenças Cardíacas , Humanos , Feminino , Masculino , Asiático/estatística & dados numéricos , Pessoa de Meia-Idade , Idoso , Emigrantes e Imigrantes/estatística & dados numéricos , Estados Unidos/epidemiologia , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/mortalidade , Aterosclerose/etnologia , Medição de Risco/métodos , Idoso de 80 Anos ou mais , Fatores de Tempo , Fatores de Risco , Peptídeo Natriurético Encefálico/sangue , China/epidemiologia , China/etnologia , Fragmentos de Peptídeos/sangueRESUMO
BACKGROUND: Troponin I is a blood biomarker of cardiac injury and levels measured using a high-sensitivity assay after pediatric heart transplantation (HT) have not been described. We sought to assess the association between high-sensitivity troponin I (hsTnI) and N-terminal pro-B-type natriuretic peptide (NTproBNP) with treated acute rejection (AR) and graft loss in pediatric heart transplant (HT) recipients. METHODS: Serum was collected and banked from pediatric HT recipients prior to cardiac catheterization. Patients with samples drawn within 365 days post-HT were included and followed for up to 5 years. Generalized linear mixed-effect models examined the association between hsTnI and treated AR using a random intercept per patient. Cox proportional hazards models tested the association between maximal hsTnI and NT-proBNP and death/graft loss. RESULTS: HsTnI and NTproBNP values decline in the weeks following HT, after which these biomarkers stabilize. HsTnI was higher in AR versus no AR (6.2 vs. 3.5 ng/L, p < 0.001); doubling of hsTnI increased the odds of AR by 33% (p = 0.004). HsTnI showed moderate discrimination for AR with an AUC of 0.811 (95% CI 0.76, 0.87) and a NPV of 96.4% (95% CI 93.0, 98.1). Elevation in NT-proBNP was not associated with AR. In multivariable Cox modeling, a doubling of maximal NT-proBNP was associated with graft loss (HR 8.96, p = 0.014). CONCLUSIONS: In this pediatric HT cohort, HsTnI was moderately discriminative for AR and higher maximal NT-proBNP was associated with graft loss. HsTnI may add value in pediatric HT non-invasive AR surveillance, and elevated NTproBNP could suggest an increased risk of graft loss.
Assuntos
Biomarcadores , Rejeição de Enxerto , Transplante de Coração , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Troponina I , Humanos , Transplante de Coração/efeitos adversos , Rejeição de Enxerto/sangue , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/etiologia , Peptídeo Natriurético Encefálico/sangue , Masculino , Feminino , Troponina I/sangue , Criança , Biomarcadores/sangue , Fragmentos de Peptídeos/sangue , Pré-Escolar , Lactente , Adolescente , Modelos de Riscos Proporcionais , SeguimentosRESUMO
BACKGROUND: Dilated cardiomyopathy (DCM) involves myocardial remodeling, characterized by significant fibrosis and extracellular matrix expansion. These changes impair heart function, increasing the risk of heart failure and sudden cardiac death. This study investigates the prognostic value of circulating fibrosis biomarkers as a less invasive method in DCM patients. METHODS: Plasma samples from 185 patients with confirmed DCM were analyzed to measure 13 circulating biomarkers using Luminex bead-based multiplex assays and ELISA. The prognostic value of these biomarkers was evaluated concerning heart failure-associated events and all-cause mortality. RESULTS: Elevated MMP-2 levels (>1519.3 ng/mL) were linked to older age, higher diabetes prevalence, lower HDL, increased NT-proBNP and hs-TnT levels, and severe systolic dysfunction. High TIMP-1 levels (>124.9 ng/mL) correlated with elevated NT-proBNP, more atrial fibrillation, reduced exercise capacity, and larger right ventricles. Increased GDF-15 levels (>1213.9 ng/mL) were associated with older age, systemic inflammation, renal impairment, and poor exercise performance. Elevated OPN levels (>81.7 ng/mL) were linked to higher serum creatinine and NT-proBNP levels. Over a median follow-up of 32.4 months, higher levels of these biomarkers predicted worse outcomes, including increased risks of heart failure-related events and mortality. CONCLUSIONS: Circulating fibrosis biomarkers, particularly MMP-2, TIMP-1, GDF-15, and OPN, are valuable prognostic tools in DCM. They reflect the severity of myocardial remodeling and systemic disease burden, aiding in risk stratification and therapeutic intervention. Integrating these biomarkers into clinical practice could improve DCM management and patient prognosis.
Assuntos
Biomarcadores , Cardiomiopatia Dilatada , Fibrose , Fator 15 de Diferenciação de Crescimento , Osteopontina , Fragmentos de Peptídeos , Inibidor Tecidual de Metaloproteinase-1 , Humanos , Cardiomiopatia Dilatada/sangue , Cardiomiopatia Dilatada/diagnóstico , Masculino , Biomarcadores/sangue , Feminino , Pessoa de Meia-Idade , Prognóstico , Inibidor Tecidual de Metaloproteinase-1/sangue , Fibrose/sangue , Fator 15 de Diferenciação de Crescimento/sangue , Fragmentos de Peptídeos/sangue , Osteopontina/sangue , Idoso , Metaloproteinase 2 da Matriz/sangue , Peptídeo Natriurético Encefálico/sangue , Adulto , Insuficiência Cardíaca/sangueRESUMO
Background and Objectives: PoCUS ultrasound applications are widely used in everyday work, especially in the field of emergency medicine. The main goal of this research was to create a diagnostic and therapeutic protocol that will integrate ultrasound examination of the lungs, ultrasound measurements of the inferior vena cava (assessment of central venous pressure) and BREST scores (risk stratification for heart failure), with the aim of establishing a more effective differential diagnostic approach for dyspneic patients. Materials and Methods: A cross-sectional study was conducted in the emergency medicine department with the educational center of the community health center of Banja Luka. Eighty patients of both sexes were included and divided into experimental and control groups based on the presence or absence of dyspnea as a dominant subjective complaint. Based on the abovementioned variables, the LUSBI protocol (lung ultrasound/BREST score/inferior vena cava) was created, including profiles to determine the nature of the origin of complaints. The biochemical marker of heart failure NT pro-BNP served as a laboratory confirmation of the cardiac origin of the complaints. Results: The distribution of NT pro BNP values in the experimental group showed statistically significant differences between individual profiles of the LUSBI protocol (p < 0.001). Patients assigned to group B PLAPS 2 had significantly higher average values of NT pro-BNP (20159.00 ± 3114.02 pg/mL) compared to other LUSBI profiles. Patients from the experimental group who had a high risk of heart failure according to their BREST scores also had a significantly higher average maximum expiratory diameter compared to those without heart failure (p = 0.004). A statistically significant difference (p = 0.001) in LUSBI profiles was observed between the groups of patients divided according to CVP categories. Conclusion: The integration of the LUSBI protocol into the differential diagnosis of dyspnea has been shown to be very effective in confirming or excluding a cardiac cause of the disease in patients.
Assuntos
Dispneia , Pulmão , Ultrassonografia , Veia Cava Inferior , Humanos , Dispneia/etiologia , Dispneia/diagnóstico , Masculino , Feminino , Estudos Transversais , Veia Cava Inferior/diagnóstico por imagem , Pessoa de Meia-Idade , Idoso , Ultrassonografia/métodos , Diagnóstico Diferencial , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Insuficiência Cardíaca/complicações , Peptídeo Natriurético Encefálico/sangue , Peptídeo Natriurético Encefálico/análise , Adulto , Fragmentos de PeptídeosRESUMO
Evidence regarding the association between cancer and heart failure (HF) is scarce. This study is to investigate the association between HF and cancer and explore the prognostic value of NT-proBNP in cancer patients. This cohort study used National Health and Nutrition Examination Survey data from 1999 to 2018 and linked mortality information until 2019. We included all participants with valid answer to questions regarding self-reported cancer and HF. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% CIs. Our study included data from 54,847 adult participants. During a median (IQR) follow-up of 9.6 (4.0-15.1) years, 7674 deaths were recorded. HF was associated with an increased occurrence of cancer after propensity score matching (OR = 1.46, 95% CI: 1.17-1.82, p < 0.001). Cancer was associated with a higher occurrence of HF (OR = 1.33, 95% CI: 1.11-1.59, p = 0.002). Kaplan-Meier survival analysis over 10 years revealed the shortest survival in patients with both HF and cancer (log-rank p < 0.0001). Importantly, NT-proBNP was significantly higher in cancer patients, no matter whether with known HF (p < 0.01). In cancer patients without HF, NT-proBNP higher than 51.51 pg/mL was associated with shorter survival (log-rank p < 0.0001). Findings from this cohort study suggest that HF is significantly associated with cancer. NT-proBNP was higher in cancer patients, with significant prognostic value in cancer patients.
Assuntos
Insuficiência Cardíaca , Peptídeo Natriurético Encefálico , Neoplasias , Inquéritos Nutricionais , Fragmentos de Peptídeos , Humanos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Peptídeo Natriurético Encefálico/sangue , Masculino , Feminino , Fragmentos de Peptídeos/sangue , Prognóstico , Neoplasias/complicações , Neoplasias/sangue , Pessoa de Meia-Idade , Idoso , Adulto , Estudos de CoortesRESUMO
The burden of heart failure (HF) has been increasing worldwide in recent decades. Early diagnosis of HF based on the outpatient measurement of natriuretic peptide (NP) concentration will allow timely initiation of the treatment and reducing the incidence of adverse outcomes in HF. Unfortunately, the frequency of NP testing remains low worldwide. At the online expert meeting held on March 15, 2024, the features of the N-terminal pro-brain natriuretic peptide (NT-proBNP) test (Elecsys proBNP by Roche) were discussed along with the interpretation of test results and presentation of results in laboratory reports. The experts addressed the features of the Elecsys proBNP test in patients with suspected HF in various clinical scenarios (chronic and acute HF). The limits of clinical decision for the NT-proBNP test were established depending on the clinical scenario. Changes in the Elecsys proBNP test results depending on the comorbidities were addressed. The experts suggested ways to optimize the format of the Elecsys proBNP test result reports in the Russian Federation, which will accelerate the implementation of the test in clinical practice and optimize the management of HF patients.
Assuntos
Tomada de Decisão Clínica , Insuficiência Cardíaca , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/terapia , Humanos , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Tomada de Decisão Clínica/métodos , Biomarcadores/sangue , Diagnóstico PrecoceRESUMO
BACKGROUND: Traumatic brain injury is a kind of injury caused by external violence on the head. Its danger is not limited to life rescue in the early stage of the disease. Moreover, the subsequent inflammatory reaction and the change in its oxidative stress level will cause secondary myocardial injury. The purpose of this study is to explore the myocardial protective effect of ozone autohemotherapy (OA) in the progression of acute traumatic brain injury (TBI). METHODS: Forty patients with acute TBI were recruited and divided into The treatment group (Group OA, n = 18) and the Control group (Group C, n = 19). Patients in Group OA received OA before surgery and on the 1st and 2nd postoperative days, while patients in Group C underwent autologous blood transfusion. Venous blood was collected from all patients before (T0) and after 7 days (T1) days of surgery for measurement of cardiac troponin T (cTnT) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP). At T0 and T1, transthoracic cardiac ultrasound was performed to measure left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), and venous blood was sampled to determine the contents of superoxide dismutase (SOD) and malondialdehyde (MDA). NIH Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores were calculated, and other clinical indexes were recorded. RESULTS: (1) The levels of cTnT at T1 were significantly higher as compared with that at T0 in both groups (p < 0.01). Compared with Group C, a remarkable decline in the content of NT-proBNP was found in Group OA at T1 (p = 0.021). (2) The LVEF (p = 0.002) and serum SOD (p = 0.015) at T1 were significantly increased in Group OA as compared with those in Group C. (3) The length of Intensive Care Unit and hospitalization time for patients in Group OA was distinctly shorter than that for patients in Group C (p = 0.021, p = 0.015, respectively). CONCLUSION: Perioperative OA treatment can alleviate the secondary myocardial injury during the disease course of TBI, which might be associated with its myocardial protective effect against oxidative stress. TRIAL REGISTRATION: This study was approved by the Ethical Committee of Changzhou NO.2 People's Hospital. The protocol was registered prospectively with the Chinese Clinical Trial Registry (ChiCTR2000029612) on February 02, 2020.