scholarly journals Acute cardiac dyspnea in the emergency department: diagnostic value of N-terminal prohormone of brain natriuretic peptide and galectin-3

2018 ◽  
Vol 47 (1) ◽  
pp. 159-172 ◽  
Author(s):  
Alexandra Stoica ◽  
Victoriţa Şorodoc ◽  
Cătălina Lionte ◽  
Irina M. Jaba ◽  
Irina Costache ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Clinical Manifestations ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Diagnostic Methods ◽  
Left Ventricular Ejection ◽  
Galectin 3

Objective This study was performed to determine whether a dual-biomarker approach using N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and galectin-3 optimizes the diagnosis and risk stratification of acute cardiac dyspnea. Atypical clinical manifestations and overlapping pathologies require objective and effective diagnostic methods to avoid treatment delays. Methods This prospective observational study included 208 patients who presented to the emergency department for acute dyspnea. NT-proBNP and galectin-3 were measured upon admission. The patients were divided into two groups according to the etiology of their clinical manifestations: cardiac and non-cardiac dyspnea. The patients’ New York Heart Association functional class, left ventricular ejection fraction, and discharge status were assessed. Results Diagnostic criteria for acute heart failure were fulfilled in 61.1% of the patients. NT-proBNP and galectin-3 were strongly and significantly correlated. Receiver operating characteristic analysis revealed similar areas under the curve for both markers in the entire group of patients as well as in the high-risk subsets of patients. Conclusions The diagnostic performance of NT-proBNP and galectin-3 is comparable for both the total population and high-risk subsets. Galectin-3 adds diagnostic value to the conventional NT-proBNP in patients with acute cardiac dyspnea, and its utility is of major interest in uncertain clinical situations.

scholarly journals The Value of Biomarkers in the Diagnosis and Prognosis of Heart Failure in Older Age

2021 ◽  
Vol 11 (2) ◽  
pp. 98-110
Author(s):  
V. N. Larina ◽  
V. I. Lunev
Keyword(s):  
Heart Failure ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Clinical Manifestations ◽  
Volume Overload ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Myocardial Stress ◽  
Outpatient Practice

The search for reliable algorithms for diagnosing heart failure with preserved left ventricular ejection fraction (LVEF) in elderly patients is an urgent problem due to the low specificity of clinical manifestations and the peculiarities of involutive processes occurring in the human body. As an alternative diagnostic approach, it is possible to determine in the blood laboratory biochemical markers — a promising method of diagnosis, prognosis and control of the effectiveness of treatment. The article examines the significance of myocardial stress markers (brain natriuretic peptide, N-terminal brain natriuretic peptide, median fragment of atrial natriuretic peptide); «mechanical» myocardial stress (soluble stimulating growth factor expressed by gene 2 — sST2), copeptin, galectin-3 in patients with heart failure and preserved LVEF, including older persons, as well as the possibility of their use in outpatient practice to predict the course of heart failure. The contribution of the multimarker model for a comprehensive assessment of prognosis is discussed, taking into account both the «hemodynamic» side of myocardial stress (pressure or volume overload, markers — natriuretic peptides), and «mechanical» (fibrosis / hypertrophy / heart remodeling, marker — sST2) myocardial changes.

Abstract 12667: Serum Brain Natriuretic Peptide Level as a Predictive Factor of Pre-Procedural Thrombi in Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Takehiro Kimura ◽  
Seiji Takatsuki ◽  
Shin Kashimura ◽  
Yoshinori Katsumata ◽  
Takahiko Nishiyama ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Brain Natriuretic Peptide ◽  
Flow Velocity ◽  
Natriuretic Peptide ◽  
Predictive Factor ◽  
Left Ventricular ◽  
Brain Natriuretic Peptide Level ◽  
Left Ventricular Ejection ◽  
Natriuretic Peptide Level ◽  
Peptide Level

Introduction: A scheduled catheter ablation for atrial fibrillation (AF) can be postponed due to preexisting thrombi in the left atrial appendage (LAA) identified by trans-esophageal echocardiography (TEE). We aimed to elucidate the predictive factor for thrombi formation. Methods: A total of 372 AF ablation candidates (male, 312; age, 59.8±10.4 years; CHA2DS2-VASc, 1.3±1.3; paroxysmal, 219) were evaluated. Warfarin was administered in 226 patients and dabigatran in 146 patients. A pre-procedural TEE identified thrombi in 24 patients (6.5%: postponed group). The patient background, pre-procedural blood sample data, transthoracic echocardiography (TTE), and TEE were compared between the performed and postponed groups. Results: Thu number of patients with hypertension (P=0.040), vascular disease (P<0.001), sleep apnea syndrome (P<0.001), and a TEE performed during AF (P=0.001) were significantly higher in the postponed group. The type of AF (paroxysmal, 11) and anticoagulants (warfarin, 16) did not differ between the groups. The age (P=0.007), CHA2DS2-VASc score (P=0.015), average flow velocity of the LAA measured using TEE (P<0.001), left ventricular ejection fraction (LVEF; P=0.006), size of the left atrium (LA; P=0.001) measured using TTE, and serum brain natriuretic peptide level (BNP; 82.4±81.4 pg/ml vs. 236.7±141.9; P<0.001) were significantly higher in the postponed group. The prothrombin time (P=0.087) and activated clotting time (P=0.178) did not differ. A multivariate analysis adjusted for the confounding factors such as the age, CHA2DS2-VASc score, LAA flow velocity, LA size and LVEF revealed that a serum BNP level of >135 pg/ml was the independent predictive factor for LAA thrombi (odds ratio, 14.178; 95% confidence interval [CI], 2.907 to 69.149; P=0.001). The area under the receiver operating characteristic (ROC) curve (AUC) for predicting a thrombus with the serum BNP level was 0.860 (95% CI: 0.775 to 0.944). The sensitivity and specificity for predicting a thrombus with a BNP value of >135 pg/ml were 81.8% and 83.6%, respectively. Conclusions: A serum BNP level of >135 pg/ml might be a noninvasive predictive factor for LAA thrombi in AF patients under anticoagulation therapy with warfarin and dabigatran.

Abstract 15083: Exercise Left Ventricular Ejection Fraction Predicts Long-term Brain Natriuretic Peptide Levels in Patients Undergoing Surgery for Severe Secondary Ischemic Mitral Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Carlo Fino ◽  
Isabelle Piazza ◽  
Bruno Vito Domenico ◽  
Philippe Pibarot ◽  
Attilio Iacovoni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Mitral Regurgitation ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Exercise Stress ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background and Objective: Surgical treatment of severe secondary ischemic mitral regurgitation (IMR) may improve symptoms and functional capacity, however there are few data on its effect on long-on the evolution of heart failure. Time-course changes in brain natriuretic peptide (BNP) are a good marker of the heart failure status and outcomes. We investigated the association between the exercise stress echocardiographic (ESE) parameters and the changes in brain natriuretic peptide (BNP) following surgery for secondary IMR. Methods: We prospectively analyzed data on 50 patients (median age: 67, 61-64 y; EF: 35, 34-40%), undergoing mitral valve annuloplasty or replacement and coronary artery bypass graft (CABG). A valve annuloplasty with undersized ring was performed in 20 patients (40%) and a replacement in 30 (60%). A six minute walking test (6-MWT), BNP levels and ESE were performed at 1 year and at median follow-up (FU) of 6 years (4-7). Results: BNP level was: 388 (329-441) pg/ml before surgery, 175 (142-743) pg/ml at 1 y, and 123 (100-979) pg/ml at last FU (p=0.2). The relative changes of BNP from baseline to last FU significantly correlated with exercise tricuspid annulus plane systolic excursion (TAPSE) at last FU (r= -0.7, p<0.001), with preoperative and FU exercise LVEF, respectively ( r=-0.7 p= 0.01) (r=-0.93, p<0.001).On multivariable analysis, preoperative exercise EF was strongly and independently associated with independent BNP levels at last FU and with the changes in BNP from baseline to last FU. Conclusions: Despite surgical treatment of severe secondary IMR, BNP levels progressively increased over time in nearly 50% of the patients. Lower preoperative and 1-year FU exercise-stress EF was associated with increased levels of BNP during FU..

P4454N-terminal pro-brain natriuretic peptide and resistance to chronic therapy with 75 mg acetylsalicylic acid assessed by point-of-care test - prospective single center study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K M Cygulska ◽  
Ł Figiel ◽  
D Slawek ◽  
A Karzkowiak ◽  
M Wraga ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Secondary Prevention ◽  
Brain Natriuretic Peptide ◽  
Acetylsalicylic Acid ◽  
Natriuretic Peptide ◽  
Predictive Value ◽  
Independent Predictor ◽  
Point Of Care ◽  
Left Ventricular ◽  
Left Ventricular Ejection

Abstract Background Acetylsalicylic acid (ASA) remains the principal medication for secondary prevention of atherosclerotic complications. Resistance to ASA (ASAres) is multifactorial and results in insufficient reduction of platelet reactivity through incomplete inhibition of thromboxane A2 (TXA2) synthesis. There is controversy regarding the optimal preventive ASA dose with common daily use of 75 mg in many European countries. Purpose The aim of our study is to reassess the prevalence and predictors of ASAres in contemporary cohort of coronary disease (CAD) patients (pts) on stable therapy with 75 mg ASA. Methods We studied 205 patients (36,6% females) with stable CAD and concomitant atherosclerotic disease history (ischemic stroke 10,2%, peripheral vascular disease 8,3%,) and type 2 diabetes in 39,5% on stable regimen 75 mg ASA for a minimum of 1 month (mean age 68,2±9,7 years, mean BMI 27,3±4,7 kg/m2). ASAres was defined as ARU (aspirin reaction unit) ≥550 using point-of-care VerifyNow Aspirin test. Exclusion criteria were: recent (up to 2 months) acute coronary syndrome, cancer, dermatological disease, epilepsy or other chronic neurological diseases, exacerbation of allergic disease, rheumatoid arthritis, periodontal disease, alcoholism, drug addiction, vegetarianism, veganism and other specific diets, and known thrombophilia. The population received standard concomitant preventive treatments including RAA blockade in 88,3%, beta-blockers in 85,9%, statins in 93,2%, and proton pump inhibitors (PPI) in 65,4%. History of infarction was present in 37% and mean left ventricular ejection fraction was 47% (18–75%). Results ASAres was detected in 11,7% of patients. Modest but significant correlations (Spearman's coefficient of rank correlation rho) were detected between ARU and C-reactive protein (CRP) (rs=0,15; p=0,030), N-terminal pro-brain natriuretic peptide (NT-proBNP) (rs=0,15; p=0,039), body weight (rs=0,22; p=0,0014), BMI (rs=0,207, p=0,0029). No significant differences in ASAres we found with regard to sex, other risk factors or concomitant medication, including PPI. However, in ASAres pts median concentrations of NT-proBNP were significantly higher (median 311 vs. 646pg/ml; p=0,046). In multivariate analysis NT-proBNP emerged as the only independent predictor of ASAres (AUC=0,626; p=0,027 with threshold value of 327,3 pg/ml resulting with negative predictive value of 16,98% and positive predictive value of 93,95% for ASAres). Conclusion ASAres has significant prevalence in this secondary prevention CAD cohort treated with 75 mg daily dose. NT-proBNP was identified as the only independent predictor in multivariate analysis. This finding may be important especially for pts with heart failure of ischemic etiology. The implications of switching into 100 mg or higher ASA doses remain to be investigated. Acknowledgement/Funding study was supported from unrestricted research grant from Aflofarm SA

Biochemical diagnosis of impaired left ventricular ejection fraction - comparison of the diagnostic accuracy of brain natriuretic peptide (BNP) and amino terminal proBNP (NT-proBNP)

2004 ◽  
Vol 42 (2) ◽  
Author(s):  
Thomas Mueller ◽  
Alfons Gegenhuber ◽  
Werner Poelz ◽  
Meinhard Haltmayer
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Diagnostic Accuracy ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Amino Terminal ◽  
Biochemical Diagnosis

AbstractThe aim of the present investigation was to evaluate the diagnostic accuracy of brain natriuretic peptide (BNP) and amino terminal proBNP (NT-proBNP) for the detection of mild/moderate and severe impairment of left ventricular ejection fraction (LVEF). In 180 subjects BNP and NT-proBNP were measured by two novel fully automated chemiluminescent assays (Bayer and Roche methods). LVEF as determined by echocardiography was categorized as normal (>60%), mildly/moderately reduced (35–60%) and severely diminished (<35%). Discriminating between patients with LVEF<35% (n=32) and subjects with LVEF ≥35% (n=148), receiver-operating characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.912 for BNP and of 0.896 for NT-proBNP (difference 0.016, p=0.554). In contrast, BNP displayed an AUC of 0.843and NT-proBNP an AUC of 0.927 (difference of 0.084, p=0.034) when comparing patients with LVEF 35–60% (n=37) and individuals with LVEF >60% (n=111). Evaluation of discordant false classifications at cut-off levels with the highest diagnostic accuracy showed advantages for BNP in the biochemical diagnosis of LVEF<35% (4 misclassifications by BNP and 25 by NT-proBNP, p<0.001) and for NT-proBNP in the detection of LVEF 35–60% (25 misclassifications by BNP and 7 by NT-proBNP, p=0.002). In conclusion, the present study indicates a different diagnostic accuracy of BNP and NT-pro-BNP for the detection of mildly/moderately reduced LVEF and severely diminished LVEF. Advantages of BNP may be advocated for the biochemical diagnosis of more severely impaired LVEF, while NT-proBNP might be a more discerning marker of early systolic left ventricular dysfunction.

Role of Troponins I and T and N-Terminal Prohormone of Brain Natriuretic Peptide in Monitoring Cardiac Safety of Patients With Early-Stage Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer Receiving Trastuzumab: A Herceptin Adjuvant Study Cardiac Marker Substudy

2017 ◽  
Vol 35 (8) ◽  
pp. 878-884 ◽  
Author(s):  
Dimitrios Zardavas ◽  
Thomas M. Suter ◽  
Dirk J. Van Veldhuisen ◽  
Jutta Steinseifer ◽  
Johannes Noe ◽  
...  
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Troponin I ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Elevated Troponin ◽  
Cardiac Marker ◽  
Ventricular Ejection Fraction ◽  
End Point

Purpose Women receiving trastuzumab with chemotherapy are at risk for trastuzumab-related cardiac dysfunction (TRCD). We explored the prognostic value of cardiac markers (troponins I and T, N-terminal prohormone of brain natriuretic peptide [NT-proBNP]) to predict baseline susceptibility to develop TRCD. We examined whether development of cardiac end points or significant left ventricular ejection fraction (LVEF) drop was associated with markers’ increases. Patients and Methods Cardiac marker assessments were coupled with LVEF measurements at different time points for 533 patients from the Herceptin Adjuvant (HERA) study who agreed to participate in this study. Patients with missing marker assessments were excluded, resulting in 452 evaluable patients. A primary cardiac end point was defined as symptomatic congestive heart failure of New York Heart Association class III or IV, confirmed by a cardiologist, and a significant LVEF drop, or death of definite or probable cardiac causes. A secondary cardiac end point was defined as a confirmed significant asymptomatic or mildly symptomatic LVEF drop. Results Elevated baseline troponin I (> 40 ng/L) and T (> 14 ng/L), occurring in 56 of 412 (13.6%) and 101 of 407 (24.8%) patients, respectively, were associated with an increased significant LVEF drop risk (univariate analysis: hazard ratio, 4.52; P < .001 and hazard ratio, 3.57; P < .001, respectively). Few patients had their first elevated troponin value recorded during the study (six patients for troponin I and 25 patients for troponin T). Two patients developed a primary and 31 patients a secondary cardiac end point (recovery rate of 74%, 23 of 31). For NT-proBNP, higher increases from baseline were seen in patients with significant LVEF drop. Conclusion Elevated troponin I or T before trastuzumab is associated with increased risk for TRCD. A similar conclusion for NT-proBNP could not be drawn because of the lack of a well-established elevation threshold; however, higher increases from baseline were seen in patients with TRCD compared with patients without.

His bundle pacing preserves left ventricular ejection fraction in patients with conduction disease and high risk of development pacing induced cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Mizner ◽  
K Curila ◽  
P Stros ◽  
R Prochazkova ◽  
J Vesela ◽  
...  
Keyword(s):  
High Risk ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Blood Levels ◽  
Funding Source ◽  
Ventricular Ejection Fraction ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Galectin 3

Abstract Background His bundle pacing (HBP), contrary to right ventricular myocardial pacing (RVP), offers the most physiological activation of both ventricles and may not lead to pacing induced cardiomyopathy. The change in myocardial structure in failing heart due to myocardial pacing should be reflected in plasmatic levels of collagen metabolism biomarkers and inflammation markers. Purpose To compare a difference in the left ventricular ejection fraction (LVEF) and levels of selected biomarkers between two groups: HBP and RVP (preferably septal). Methods Eighty-six patients with conduction disease indicated to permanent cardiac pacing were randomized to HBP or RVP. Only high-risk patients for pacing induced cardiomyopathy development were included. Blood sampling and echocardiography were performed on the consequent day and 180 days after the pacemaker implantation. The measured biomarkers were: matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1), galectin-3 (GAL3), ST2/IL-33R (ST2/IL) and TGF-beta 1 (TGFβ1). Statistical analysis included Students t-test, Fishers exact test and Chi-squared test. The p&lt;0.05 was considered to be statistically significant. Results First group included 39 patients with HBP (selective or non-selective His bundle capture) and 47 patients with RVP. Both groups were similar with respect to gender, LVEF, QRS duration and the baseline levels of evaluated biomarkers. In both groups, there was a high burden of ventricular pacing after 6 months (above 90%) (p = NS). The ejection fraction of the left ventricle did not change in the HBPgroup (60 vs 60%, p=0,3), but it decreased significantly in the RVP group (59 vs 56%, p=0,004). The decline in the LVEF of at least 5% occurred in 12 patients (26%) from RVP group, compared to 3 patients (8%) in HBP group (p=0,03). The blood levels of dMMP-9 (p=0,02), TIMP-1 (p=0,003), ST2/IL (p=0,003) and TGFβ1 (p=0,021) declined significantly after 180 days in the HBP group, decline of Galectin 3 was nonsignificant. In the RVP group, there was a significant decline in blood levels of MMP-9 (p=0,014), TIMP-1 (p=0,001) and ST2/IL (p= 0,04), decline of Galectin 3 and TGFβ1 was nonsignificant. The biomarker level difference was not statistically significant between the two groups. Conclusion His bundle pacing, contrary to right ventricular myocardial pacing, preserves LVEF in patients with high risk of pacing induced cardiomyopathy development. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Charles University research programme. Q38. UNCE/MED/002

Significance of Brain Natriuretic Peptide Measurement as a Diagnostic Indicator of Cardiac Function

2000 ◽  
Vol 39 (03) ◽  
pp. 249-253 ◽  
Author(s):  
N. Iida ◽  
T. Ishihara ◽  
S. Waku
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Control Group ◽  
Healthy Control ◽  
Group 5 ◽  
Lv Diastolic Dysfunction

AbstractBrain natriuretic peptide (BNP) is increased in patients with heart failure due to myocardial infarction and cardiac hypertrophy, in proportion to the severity of left ventricular dysfunction. The aims of this study were to clarify the clinical features of BNP and to determine the diagnostic value of BNP for mass screening.The subjects were 818 office workers (565 males and 253 females; mean age 47 ± 12 years) who participated in a 1996 routine health check at Kansai University All individuals were examined for blood pressure, serological findings, ECG and plasma BNP level. Thirty-three males underwent 2-D echocardiography. Plasma BNP levels were measured using IRMA (immunoradiometric assay).The results were as follows: (1) BNP levels in females were higher than those in males for healthy subjects (N = 551), in each age group from 20 to 60 years. (2) BNP levels increased with age. (3) There were significant correlations between BNP level and systolic blood pressure and creatinine level. (4) There were significant differences in BNP level between the hypertensive groups with and without hypertensive ECG changes and the age-matched healthy control group. (5) Marked correlations were observed between BNP level and left ventricular wall thickness, fractional shortening, deceleration time and peak early filling velocity. (6) A BNP cut-off-point of 25 pg/ml was best for detecting LV diastolic dysfunction and LV hypertrophy. Measurement of BNP is useful for detecting asymptomatic heart failure in the general population, and is a clinical marker useful in preventing symptomatic heart failure.

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