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Objective:To correlate serum Nesfatin-1, N-terminal pro-brain natriuretic peptide (NT-proBNP), and cystatin C (CysC) levels with myocardial enzymes and cardiac function in patients with acute ST-elevation myocardial infarction (STEMI).Methods:This is a case-control study. A total of 100 patients with acute STEMI who received treatment at Lishui People's Hospital from January 2020 to December 2022 were included in the STEMI group. An additional 80 healthy controls who concurrently received physical examinations in the same hospital were included in the control group. Serum levels of Nesfatin-1, NT-proBNP, CysC, creatine kinase-MB (CK-MB), and cardiac troponin I (cTnI) levels were determined in each group. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDD), and left ventricular end-systolic diameter (LVDS) were measured using color Doppler ultrasound. Correlation analysis was performed.Results:Serum Nesfatin-1 level in the STEMI group was (89.96 ± 15.25) ng/L, which was significantly lower than (226.36 ± 37.47) ng/L in the control group ( t = 33.15, P < 0.05). Serum levels of NT-proBNP and CysC in the STEMI group were (1 325.12 ± 378.48) ng/L and (1.37 ± 0.24) mg/L, which were significantly higher than (78.95 ± 13.42) ng/L and (0.79 ± 0.16) mg/L in the control group ( t = -29.42, -18.56, both P < 0.05). Serum CK-MB and cTnI levels in the STEMI group were (46.51 ± 12.14) U/L and (1.13 ± 0.25) U/L, respectively, which were significantly higher than (12.23 ± 4.01) U/L and (0.09 ± 0.02) U/L in the control group ( t = -24.06, -37.09, both P < 0.05). The LVEF in the STEMI group was (37.84 ± 5.45)%, which was significantly lower than (72.41 ± 4.26)% in the control group ( t = 46.49, P < 0.05). The LVDD and LVDS in the STEMI group were (40.92 ± 5.25) mm and (58.98 ± 6.25) mm, which were significantly higher than (19.86 ± 3.36) mm and (34.21 ± 4.38) mm in the control group ( t = -31.13, -30.03, both P < 0.05). Serum Nesfatin-1 level was positively correlated with LVEF ( r = 0.572), but it was negatively correlated with serum CK-MB and cTnI levels, LVDD, and LVDS ( r = -0.498, -0.617, -0.506, -0.534, all P < 0.05). Serum NT-proBNP and CysC levels were negatively correlated with LVEF ( r = -0.653, -0.607), but they were positively correlated with serum CK-MB and cTnI levels, LVDD, and LVDS ( r = 0.582, 0.526, 0.712, 0.565, 0.631, 0.578, 0.659, 0.635, all P < 0.05). Conclusion:Serum Nesfatin-1 levels decrease, while serum NT-proBNP and CysC levels increase in patients with acute STEMI. Serum Nesfatin-1, NT-proBNP, and CysC levels are closely related to myocardial enzymes and cardiac function.
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Objective:To investigate the efficacy of trimetazidine in the treatment of atrial arrhythmias in patients with ischemic cardiomyopathy and heart failure and analyze the effect of trimetazidine on cardiac function and atrial arrhythmias.Methods:A total of 79 patients with ischemic cardiomyopathy and heart failure who received treatment at the Second Hospital of Jiaxing from December 2018 to June 2020 were included in this study. These patients were randomly divided into an observation group ( n = 41) and a control group ( n = 38). Patients in the control group received conventional drugs, while those in the observation group received trimetazidine sustained-release tablets twice daily, each time taking 35 mg in addition to conventional drugs. The treatment lasted for 24 weeks. Before and after treatment, cardiac function indicators (left ventricular ejection fraction, B-type brain natriuretic peptide, 6-minute walking distance), cardiac color Doppler ultrasound indicators [ratio of early to late peak filling rate (E/A ratio)], left ventricular fractional shortening), electrocardiogram parameters (maximum P-wave duration, minimum P-wave duration, and P-wave dispersion), dynamic electrocardiogram parameters [number of single atrial premature beats, total number and duration of paroxysmal atrial tachycardia episodes, total number and duration of paroxysmal atrial flutter/fibrillation attacks, standard deviation of RR intervals, root mean square of successive differences between normal heartbeats, proportion of successive RR intervals that differ by more than 50 ms divided by the total number of NN intervals (PNN50), standard deviation of average NN intervals, high frequency and low frequency], as well as changes in high sensitivity C-reactive protein were analyzed in each group. Results:After treatment, left ventricular ejection fraction, B-type brain natriuretic peptide, 6-minute walking distance, maximum P-wave duration, P-wave dispersion, total number of atrial flutter/atrial fibrillation attacks, and duration of atrial flutter/atrial fibrillation in the observation group were (51.05 ± 7.68)%, (1 615.59 ± 1 129.78) ng/L, (350.02 ± 62.99) m, (99.73 ± 11.60) ms, (22.44 ± 12.03) ms, (0.22 ± 0.61), and (4.59 ± 12.30) minutes, respectively, which were significantly superior to (46.82 ± 7.34)%, (2 267.47 ± 1 539.03) ng/L, (294.16 ± 58.20) m, (111.71 ± 10.00) ms, (36.77 ± 15.07) ms, (0.76 ± 1.13), (15.66 ± 22.30) minutes in the control group, t = -2.95, 2.16, -4.08, 4.89, 4.68, 2.69, 2.76, all P < 0.01). Conclusion:Trimetazidine can effectively reduce atrial arrhythmias and improve the prognosis of patients with ischemic cardiomyopathy and heart failure, which warrants clinical promotion.
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Objective:To investigate associations between cardiac biomarkers with stroke severity and short-term outcome in patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to the Affiliated Hospital of Qingdao University from June 2018 to February 2024 whose etiological classification was large artery atherosclerosis (LAA), small vessel occlusion (SVO) or cardioembolism (CE) were included retrospectively. According to the National Institutes of Health Stroke Scale score at admission, patients were divided into mild stroke group (≤8) and moderate to severe stroke group (>8). According to the modified Rankin Scale score at discharge, patients were divided into good outcome group (≤2) and poor outcome group (>2). Multivariate logistic regression analysis was used to determine the independent correlation between cardiac biomarkers and short-term outcome. The predictive value of cardiac biomarkers for poor outcome in patients with AIS and different stroke etiology subtypes were evaluated using receiver operating characteristic (ROC) curves. Results:A total of 2 151 patients with AIS were enrolled, including 1 256 males (58.4%), aged 67.40±11.34 years. 1 079 patents were LAA type (50.2%), 679 were SVO type (31.6%), and 393 were CE type (18.3%); 1 223 were mild stroke (56.86%) and 928 (43.14%) were moderate to severe stroke; 1 357 patients (63.09%) had good short-term outcome, and 794 (36.91%) had poor short-term outcome. Multivariate logistic regression analysis showed that N-terminal pro-B type natriuretic peptide (NT-proBNP), NT-proBNP/creatine kinase (CK) isoenzyme MB (CK-MB) ratio, and CK-MB/CK ratio were independent risk factors for poor short-term outcome. ROC curve analysis shows that the CK-MB/CK ratio had a higher predictive value for short-term poor outcome in patients with AIS (the area under the curve, 0.859, 95% confidence interval 0.839-0.879). Various cardiac biomarkers had a higher predictive value for short-term outcome of CE type and LAA type, but the predictive value for short-term outcome of SVO type was lower. Conclusions:Cardiac biomarkers are associated with the severity and poor outcome of AIS. NT-proBNP/CK-MB and CK-MB/CK ratios have higher predictive value for short-term poor outcome of AIS, especially in patients with CE type.
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Objective To investigate the influences of arctigenin(ATG)on ventricular remodeling and inflammatory reaction in chronic heart failure(CHF)rats,and to analyze its potential mecha-nism.Methods A total of 79 SD rats were randomly divided into sham operation group(n=12),and the remaining rats were inflicted with abdominal aortic coarctation to establish a rat CHF model.After modeling,60 CHF rats were randomly divided into CHF group,low and high dose ATG group(ATG-L and ATG-H groups,10 and 20 mg/kg,respectively),ATG+NC group[20 mg/kg ATG+100 μl high mobility group protein B1(HMGB1)negative control plasmid],and ATG+HMGB1 group(20 mg/kg ATG+100 pl HMGB1 overexpression plasmid),with 12 rats per group.After 4 weeks of corresponding intervention,heart function,levels of B-type brain na-triuretic peptide(BNP),N-terminal B-type brain natriuretic peptide precursor(NT-proBNP)andIL-6 and TNF-α,heart mass index(HMI)and left ventricular mass index(LVMI),pathological changes of myocardial tissue,cross-sectional area of myocardial cells and myocardial collagen vol-ume fraction(CVF)and protein expression of HMGB1/Toll-like receptor 4(TLR4)/NF-κB sig-naling pathway in left ventricular myocardial tissue were measured.Results Compared with the sham operation group,myocardial tissue HMGB1(0.42±0.05 vs 0.15±0.02)and TLR4(0.70± 0.09 vs 0.21±0.04)protein levels,and phosphorylated NF-κB p65(p-NF-κB p65)/NF-κB p65(0.73±0.09 vs 0.26±0.05)protein ratio were obviously increased in the CHF group,while the left ventricular ejection fraction(LVEF)and left ventricular short-axis fractional shortening(LVFS)were obviously decreased(P＜0.05).Myocardial tissue HMGB1(0.33±0.04、0.24±0.04 vs 0.42±0.05)and TLR4(0.56±0.06、0.41±0.05 vs 0.70±0.09)protein levels,and p-NF κB p65/NF-KB p65(0.61±0.08、0.49±0.06 vs 0.73±0.09)protein ratio were decreased,and the LVEF and LVFS were increased in the ATG-L group and ATG-H group than the CHF group(P＜0.05).Overexpression of HMGB1 obviously attenuated the inhibitory effects of ATG on HMGB1/TLR4/NF-κB signaling pathway,ventricular remodeling,and inflammatory reaction in CHF rats(P＜0.05).Conclusion ATG may suppress ventricular remodeling in CHF rats by in-hibiting HMGB1/TLR4/NF-κB signaling inflammatory pathway.
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Objective:To investigate the clinical efficacy of daggliflozin in the treatment of type 2 diabetes mellitus complicated by coronary heart disease and cardiac insufficiency.Methods:Seventy patients with type 2 diabetes mellitus complicated by coronary heart disease and cardiac insufficiency who received treatment in The Second People's Hospital of Liaocheng, The Second Hospital of Liaocheng Affiliated to Shandong First Medical University from March 2021 to February 2022 were included in this study. They were randomly divided into a control group ( n = 35) and an observation group ( n = 35). Based on conventional treatment, the control group was treated with metformin, while the observation group was treated with daggliflozin. Both groups were treated for 6 months. Pre- and post-treatment blood glucose and cardiac function as well as adverse reactions and prognosis were compared between the two groups. Results:After treatment, fasting blood glucose, 2-hour post-prandial glucose, glycosylated hemoglobin, fasting insulin, 2-hour post-prandial insulin level, left ventricular end-diastolic diameter, and peripheral blood N-terminal B-type natriuretic peptide levels in the observation group were (6.69 ± 1.83) mmol/L, (9.30 ± 2.96) mmol/L, (7.50 ± 0.98)%, (9.23 ± 2.80) mIU/L, (55.36 ± 8.38) mIU/L, (52.06 ± 5.39) mm, and (5.02 ± 1.98) μg/L, respectively, and they were (7.68 ± 2.03) mmol/L, (10.98 ± 3.33) mmol/L, (8.09 ± 1.25)%, (10.60 ± 2.26) mIU/L, (60.26 ± 8.98) mIU/L, (55.06 ± 5.86) mm, and (6.16 ± 2.28) μg/L, respectively, in the control group. There were significant differences in these indexes between the two groups ( t = 2.14, 2.23, 2.19, 2.25, 2.36, 2.22, 2.23, all P < 0.05). The left ventricular ejection fraction and 6-minute walking test in the observation group were (40.06 ± 5.26)% and (370.69 ± 52.26) m, which were significantly higher than (37.35 ± 4.33)% and (343.98 ± 38.69) m in the control group ( t = 2.35, 2.43, both P < 0.05). During the treatment period, there were no deaths in either group. Conclusion:Daggliflozin combined with conventional treatment can greatly improve glycemic control in patients with diabetes mellitus complicated by coronary heart disease and cardiac insufficiency. The combined therapy contributes to the improvement in cardiac function and is therefore worthy of promotion.
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Objective:To investigate the efficacy of phenolamine in the treatment of sepsis-induced myocardial dysfunction and its effect on cardiac function, myocardial injury index, and hemodynamics in patients.Methods:The clinical data of 79 patients with sepsis-induced myocardial dysfunction who received treatment in Huangshi Central Hospital, Edong Healthcare Group from February 2017 to February 2020 were retrospectively analyzed. These patients were divided into a control group (without phenolamine treatment, n = 41) and an observation group (with phenolamine treatment, n = 38) according to whether they received phenolamine treatment or not. Clinical efficacy, cardiac function, myocardial injury index, and hemodynamic index pre- and post-treatment were compared between the two groups. Results:There was no significant difference in 28-day mortality rate between the two groups ( P > 0.05). Intensive care unit length of stay and mechanical ventilation duration in the observation group were (9.33 ± 3.52) days and 83.00 (28.50, 138.00) hours, which were significantly shorter than (12.17 ± 4.15) days and 111.00 (47.50, 169.00) hours in the control group ( t = 3.26, Z = -2.27, both P < 0.05). The response rate in the observation group was significantly higher than that in the control group [81.58% (31/38) vs. 60.98% (25/41), χ2 = 4.05, P < 0.05]. After 7 days of treatment, the left ventricular ejection fraction in each group was significantly increased, and the left ventricular end-diastolic diameter and left ventricular end-systolic diameter in each group were significantly decreased compared with before treatment (all P < 0.05). After 7 days of treatment, the left ventricular ejection fraction in the observation group was significantly higher than that in the control group ( t = 3.29, P < 0.05), and left ventricular end-diastolic diameter and left ventricular end-systolic diameter were significantly lower than those in the control group ( t = 5.94, 11.21, both P < 0.05). N-terminal pro-brain natriuretic peptide and cardiac troponin I levels in each group were significantly decreased with time (both P < 0.05). At 24 and 72 hours and 7 days after treatment, N-terminal pro-brain natriuretic peptide and cardiac troponin I levels in the observation group were significantly lower than those in the control group (both P < 0.05). After 7 days of treatment, heart rate in each group decreased significantly compared with that before treatment (both P < 0.05), mean arterial pressure, cardiac index, and stroke output index in each group increased significantly compared with those before treatment (all P < 0.05). After 7 days of treatment, heart rate in the observation group was significantly lower than that in the control group ( t = 4.90, P < 0.05), and mean arterial pressure, cardiac index, and stroke output index in the observation group were significantly higher than those in the control group ( t = 4.37, 3.23, 6.01, all P < 0.05). Conclusion:Phentolamine can improve hemodynamics, reduce myocardial injury and improve cardiac function in patients with sepsis-induced myocardial dysfunction.
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Objective:To analyze the risk factors of postoperative recurrence of nonvalvular paroxysmal and persistent atrial fibrillation.Methods:A total of 100 patients who received treatment in Haining People's Hospital from October 2019 to October 2021 were included in this study. All patients were followed up for 1 year. Thirty patients with postoperative recurrence of atrial fibrillation were included in the observation group, and seventy patients without postoperative recurrence of atrial fibrillation were included in the control group. Univariate and multivariate logistic regression analyses were performed to analyze the risk factors of postoperative recurrence of atrial fibrillation after radiofrequency ablation.Results:Logistic regression analysis results revealed that age, body mass index, diabetes mellitus, hypertension, rheumatic heart disease, anteroposterior diameter of the left atrium, glycosylated hemoglobin, brain natriuretic peptide are the risk factors of recurrent atrial fibrillation after radiofrequency ablation (all P < 0.05) ( OR = 1.31, 1.33, 1.32, 1.34, 1.26, 1.24, 1.36, 1.33; 95% CI = 1.028-1.442, 1.031-1.427, 1.042-1.434, 1.124-1.452, 1.013-1.385, 1.005-1.326, 1.039-1.482, 1.064-1.478). Conclusion:The recurrence of nonvalvular paroxysmal and persistent atrial fibrillation after radiofrequency ablation is related to many factors. The risk factors should be taken into account in clinical practice, and targeted treatment should be given as early as possible to reduce the recurrence rate of atrial fibrillation and improve prognosis.
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Objective:To investigate the clinical efficacy of sacubitril and valsartan combined with bisoprolol in the treatment of chronic heart failure and its effect on N-terminal pro-brain natriuretic peptide (NT-pro BNP) level.Methods:The clinical data of 89 patients with chronic heart failure who received treatment in Jinan 2 nd People's Hospital from January 2020 to April 2022 were retrospectively analyzed. These patients were divided into Group A ( n = 48) and Group B ( n = 41) according to different treatment methods. Group A was treated with sacubitril and valsartan combined with bisoprolol. Group B was treated with sacubitril and valsartan combined with metoprolol. All patients were treated for 3 months. Clinical efficacy as well as heart function and NT-pro BNP level pre- and post-treatment were compared between the two groups. The incidence of adverse reactions was calculated in each group. Results:Total response rate in group A was significantly higher than that in group B [95.83% (46/48) vs. 82.93% (34/41), χ2 = 4.05, P < 0.05]. After treatment, the left ventricular ejection fraction in both groups increased significantly and the left ventricular ejection fraction in group A was significantly higher than that in group B ( t = 2.19, P < 0.05). After treatment, NT-pro BNP level in group A was (416.51 ± 30.56) ng/L, which was significantly lower than (450.20 ± 35.79) ng/L in group B ( t = 4.79, P < 0.001). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:The efficacy of sacubitril and valsartan combined with bisoprolol in the treatment of chronic heart failure is superior to that of sacubitril and valsartan combined with metoprolol. The former can greatly decrease NT-pro BNP level. Corresponding drugs can be selected for the treatment of chronic heart failure according to the actual needs of patients.
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Objective:To investigate the risk factors according to the clinical data of the adult patients with acute moderate to high risk pulmonary thromboembolism (PTE).Methods:The clinical data of 100 adult patients with acute moderate-risk PTE in Hunan Provincial People′s Hospital from June 2019 to March 2022 were analyzed retrospectively. According to the risk stratification, they were divided into moderate to low risk group (34 cases) and moderate to high risk group (66 cases). The laboratory data and clinical data of all adult patients were collected, and the independent risk factors of acute moderate to high risk PTE in adults were analyzed by binary logistic regression; Receiver operating characteristic (ROC) curve was used to analyze the predictive ability of independent risk factors for acute moderate to high risk PTE.Results:There were 34 patients with moderate to low risk PTE, 20 males and 14 females, aged 16-86 (60.2±15.5)years, 66 patients with moderate to high risk PTE, 36 males and 30 females, aged 34-82(63.6±9.6)years. There was no significant difference in age, gender and risk factors between the two groups (all P>0.05). The tumor history of concomitant diseases in moderate to high risk group was significantly higher than that in moderate to low risk group, and the symptoms of dyspnea and shortness of breath in moderate to high risk group were significantly higher than those in moderate to low risk group (all P>0.05). The levels of troponin I, shock index (SI) and N-terminal B-type brain natriuretic peptide precursor (NT-proBNP) in moderate to high risk group were significantly higher than those in moderate to low risk group, while the levels of PaO 2 and oxygenation index in moderate to high risk group were significantly lower than those in moderate to low risk group, with statistical significant difference (all P<0.05). Echocardiographic results showed that there were significant differences in right ventricular inner diameter (RV), left ventricular inner diameter (LV), RV/LV, tricuspid regurgitation velocity and pulmonary systolic pressure between moderate to high risk PTE patients and moderate to low risk PTE patients (all P>0.05). CTPA results showed that RV, RV/LV, main pulmonary artery diameter and thrombus load in moderate to high risk PTE patients were significantly higher than those in moderate to low risk PTE patients (all P<0.05). Multivariate binary logistic regression analysis showed that SI, NT-proBNP and RV were independent predictors of moderate to high risk PTE (all P<0.05). The combined detection of SI, NT-proBNP and RV had a good predictive value for moderate to high risk PTE. The area under ROC curve (AUC) was 0.984, the sensitivity and specificity were 90.32% and 97.73%, respectively. The negative predictive value was 87.8%, and the positive predictive value was 98.2%. Conclusions:SI, NT-proBNP, RV of echocardiography and RV of CTPA are the predictors of acute moderate to high risk PTE in adults, which provided a strong supplement for the risk stratification of acute moderate risk PTE in adults.
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Objective:To evaluate the association of different biomarkers with frailty in elderly hospitalized patients.Methods:In this cross-sectional study, a total of 319 elderly patients aged 65 years or older hospitalized in Beijing Hospital between September 2018 and February 2019 were enrolled.Patients had a mean age of(75.0±6.6)years and 151(47.3%)were women.Based on the Fried phenotype, patients were divided into a non-frail group(244 cases, 76.5%)and a frail group(75 cases, 23.5%). The clinical characteristics and biomarker levels of the two groups were compared.The association of different biomarkers with frailty was evaluated by using the receiver operating characteristic(ROC)curve.The Youden index was used for the optimal cutoff values and the area under the curve(AUC)were calculated.AUCs of different biomarkers were compared to assess their correlations with frailty.Results:Hemoglobin, lipid levels(triglycerides, total cholesterol and low-density lipoprotein cholesterol), and prealbumin were significantly lower in the frail group than in the non-frail group( P<0.05), while N-terminal pro-B type natriuretic peptide(NT-proBNP)and high-sensitivity C reactive protein(hsCRP)levels were significantly higher than in the non-frail group( P<0.05). Thyrotropin(TSH)and free triiodothyronine(FT3)levels were significantly lower( P<0.05)and trans-triiodothyronine(rT3)was significantly higher( P<0.05)in the frail group.The combination of six biomarkers[hemoglobin, prealbumin, hsCRP, 25-dihydroxy vitamin D3[25(OH)D3], rT3 and NT-pro BNP]had the most powerful correlation with frailty(AUC=0.705, 95% CI: 0.652-0.755), but the correlation was not significantly different from that of the combination of 3 markers(hemoglobin, rT3 and hsCRP)(ROC=0.010, 95% CI: -0.0106-0.0306, P>0.05). Either of the two combinations was significantly better than the combination of 2 markers(hemoglobin and rT3)(ROC=0.143, 95% CI: 0.0406-0.245; ROC=0.153, 95% CI: 0.0498-0.256; all P<0.01). Conclusions:Hemoglobin, lipids, prealbumin, TSH and FT3 levels decrease while NT-proBNP and hsCRP levels increase in elderly hospitalized frail patients.The 6-biomarker combination[hemoglobin, prealbumin, hsCRP, 25(OH)D3, rT3 and NT-pro BNP]and 3-biomarker combination(hemoglobin, rT3 and hsCRP)have better correlation with frailty than the 2-biomarker combination(hemoglobin and rT3).
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Objective:To explore the clinical value of N terminal pro B type natriuretic peptide (NT-proBNP) in diagnosing or predicting heart failure in peridialysis chronic kidney disease (CKD) population.Methods:It was a single-center retrospective study. Patients with peridialysis CKD who visited the Department of Nephrology, First Affiliated Hospital of Zhengzhou University from January 2021 to June 2021 were collected and divided into 4 groups according to the presence or absence of heart failure and the level of left ventricular ejection fraction (LVEF), namely the non-heart failure group, heart failure with reduced ejection fraction (HFrEF) group (LVEF<40%), heart failure with mid-range ejection fraction (HFmrEF) group (40％≤LVEF<50％), and heart failure with preserved ejection fraction (HFpEF) group (LVEF≥50％). The NT-proBNP, echocardiography and other indicators of the 4 groups were compared. The value of plasma NT-proBNP in diagnosing heart failure, HFpEF, HFmrEF and HFrEF was analyzed by drawing receiver operating characteristic curve (ROC curve). Logistic regression analysis was used to analyze the related factors of heart failure in peridialysis CKD patients.Results:A total of 508 patients were included, including 11 cases in the HFrEF group, 29 cases in the HFmrEF group, 152 cases in the HFpEF group, and 316 cases without heart failure. The differences in age, 24-h urine volume, hemodialysis proportion, non-dialysis proportion, serum creatinine, estimated glomerular filtration rate, hemoglobin, serum albumin, C-reactive protein, NT-proBNP, cardiac troponin I, left ventricular internal diameter, LVEF, pulmonary artery systolic pressure, left ventricular end-diastolic volume, E/A value, septal thickness, and left ventricular posterior wall thickness among the four groups were statistically significant ( P < 0.05, respectively). A two-pair comparison (all P values corrected by Bonferroni method) revealed that the 24-h urine volume was higher in the non-heart failure group than in the other three groups (corrected P<0.05, respectively), while the proportion of hemodialysis patients and the levels of NT-proBNP and C-reactive protein were lower in the non-heart failure group than in the other three groups (corrected P<0.001, respectively); the levels of hemoglobin and serum albumin were lower in the HFpEF group than in the non-heart failure group (corrected P<0.001, respectively); troponin I was lower in the non-heart failure group than in the HFpEF group (corrected P<0.001), HFmrEF group (corrected P=0.001) and HFrEF group (corrected P<0.001), and troponin I was lower in the HFpEF group than in the HFrEF group (corrected P=0.008); LVEF was higher in the non-heart failure group than in the other three groups (corrected P<0.001, respectively), and LVEF in the HFpEF group was higher than in the HFmrEF and HFrEF groups (corrected P<0.001, respectively). For patients with peridialysis CKD, the cut-off values of plasma NT-proBNP for diagnosing or predicting heart failure, HFpEF, HFmrEF and HFrEF were 4 943.33 ng/L, 4 976.83 ng/L, 14 964.5 ng/L and 17 847.55 ng/L, respectively. Multivariate logistic regression analysis showed that NT-proBNP (every 500 ng/L increase, OR=1.390, 95% CI 1.287-1.501, P<0.001), LVEF ( OR=0.747, 95% CI 0.656-0.851, P<0.001) and 24-h urine volume (every 100 ml increase, OR=0.842, 95% CI 0.763-0.929, P=0.001) were independently correlated with heart failure. Conclusions:The cut-off value of plasma NT-proBNP for diagnosing or predicting heart failure in peridialysis CKD patients is much higher than that in patients with normal renal function. NT-proBNP, LVEF and 24-h urine volume are independently associated with heart failure in peridialysis CKD patients.
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ABSTRACT Introduction: Upper airway obstruction (UAO) is a common condition in all pediatric population, with a 27% prevalence. Primary monosymptomatic nocturnal enuresis (PMNE) is a condition related to UAO in 8% to 47% of these children. The specific pathophysiological mechanism of this bond is not well understood. Some authors suggest a connection between brain natrituretic peptide (BNP) and anti-diuretic hormone (ADH) during sleep. The aim of this study was to evaluate hormone profile (ADH and BNP) and improvement in dry nights in a sample of children before and after surgical treatment of the UAO. Methods: This is a longitudinal prospective interventionist study in children, 5 to 14 years of age, with UAO and PMNE recruited in a specialty outpatient clinic. Children presenting UAO and PMNE were evaluated with a 30-day dry night diary and blood samples were collected to evaluate ADH and BNP before and after upper airway surgery. Data were analyzed prior to surgery and 90-120 days after surgery. Results: Twenty-one children with a mean age of 9.7 years were included. Mean BNP before surgery was 116.5 ± 126.5 pg/mL and 156.2 ± 112.3 pg/mL after surgery (p<0.01). Mean ADH was 5.8 ± 3.2 pg/mL and 14.6 ± 35.4 before and after surgery, respectively (p=0.26). The percentage of dry nights went from 32.3 ± 24.7 before surgery to 75.4 ± 33.4 after surgery (p<0.01). Conclusion: Surgery for airway obstruction contributed to an increase in BNP without increasing ADH. A total of 85.8% of the children presented partial or complete improvement of their enuresis.
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Abstract Background Brain natriuretic peptide (BNP) and troponin have a close relationship with cardiogenic cerebral embolism (CCE), but their relationship with noncardiogenic patients with anterior circulation ischemia (ACI) and posterior circulation ischemia (PCI) is not clear. Objective To explore the predictive value of serum initial BNP and troponin on the functional prognosis of patients with noncardiogenic ACI and PCI. Methods Consecutive patients with first-episode cerebral infarction within 12 hours of symptom onset were enrolled in the present 1-year prospective cohort study. Serum levels of BNP and troponin were collected within 12 hours of onset. Infarction location was classified as ACI and PCI by magnetic resonance imaging (MRI). According to the modified Rankin Scale (mRS) score at 90 days after onset, ACI and PCI cases were respectively divided into a good prognosis group (mRS score between 0 and 2) and a poor prognosis group (mRS score between 3 and 6). The general state of health and results of laboratory examinations and other auxiliary examinations of all patients were recorded. Single-factor analysis and multivariate logistic regression analysis were used to assess the relationship between serum levels of BNP, troponin, and functional outcome. Results The multivariate logistic regression found that higher levels of initial BNP (odds ratio [OR] = 1.024; 95% confidence interval [CI]: 1.006-1.041; p = 0.007) and C-reactive protein (CRP) (OR = 1.184; 95%CI: 1.024-1.369; p = 0.022) were independent predictors of poor functional prognosis of noncardiogenic PCI at 90 days after onset after adjusting for age, gender, ethnicity, history of hypertension and of diabetes. Conclusions The levels of initial BNP and CRP were related to poor functional outcomes in noncardiogenic PCI patients at 3 months, independent of troponin.
Resumo Antecedentes O peptídeo natriurético cerebral (BNP, na sigla em inglês) e a troponina estão intimamente relacionados com a embolia cerebral cardiogênica (CCE, na sigla em inglês), mas a relação com pacientes não cardioembólicos com isquemia de circulação anterior (ICA) e isquemia de circulação posterior (ICP) não é clara. Objetivo Investigar o valor preditivo dos níveis séricos iniciais do BNP e da troponina no prognóstico de pacientes com AVC isquêmico não cardiogênico. Métodos Os níveis séricos de BNP e de troponina foram recolhidos de pacientes com primeiro episódio de acidente vascular cerebral (AVC) isquêmico dentro de 12 horas após o início dos sintomas, com localização classificada como ICA e ICP de acordo com exame de ressonância magnética (RM). De acordo com a pontuação modificada da escala de Rankin (mRS), aos 90 dias após o início dos sintomas, ICA e ICP foram divididas respectivamente em um grupo de bom prognóstico (mRS entre 0 e2) e em um grupo de mau prognóstico (mRS entre 3 e 6). Foram registrados exames laboratoriais e outros exames complementares de todos os pacientes. Foram utilizadas análise fatorial única e análise de regressão logística multivariada para investigar a relação entre os níveis séricos de BNP e de troponina e o resultado funcional. Resultados A regressão logística multivariada evidenciou que os níveis mais altos de BNP inicial (odds ratio [OR] = 1,024, intervalo de confiança [IC] de 95%: 1,006-1,041; p = 0,007) e proteína C reativa (CRP, na sigla em inglês) (OR = 1,184; 95%CI: 1,024-1,369; p = 0,022) foram preditores independentes de mau prognóstico funcional da ICP não cardiogênica aos 90 dias após o início dos sintomas. Conclusões Os níveis iniciais de BNP e CRP se associaram a maus resultados funcionais em pacientes com ICP não cardiogênica aos três meses, independentemente da troponina.
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Objective:To investigate the prevalence of uremic pruritus and related factors in patients undergoing hemodialysis.Methods:A total of 212 patients with uremia who undergo hemodialysis in the First Affiliated Hospital of Xiamen University in March 2021 were included in this cross-sectional study. Data including gender, age and blood biochemical indicators were collected. The 5D itch scale was used to evaluate skin itch in patients. The included patients were divided into pruritus and no pruritus groups according to evaluation results. Related indicators were compared between the two groups. Binary logistic regression analysis of skin itch related factors was performed.Results:According to 5D itch scale evaluation results, 129 patients (60.85%) of the 212 patients had no skin pruritus, and 83 patients (39.15%) had skin pruritus. In the pruritus group, age, hypersensitive C-reactive protein, alkaline phosphatase, brain natriuretic peptide, ferritin were 63.0 (51.0, 72.0) years, 1.66 (0.30, 7.85) mg/L, 93.0 (70.0, 118.0) U/L, 192.0 (84.9, 446.4) ng/L and 421.0 (291.6, 577.6) μg/L, respectively, which were significantly higher than 53.0 (42.0, 63.0) years, 0.40 (0.30, 1.88) mg/L, 79.0 (62.0, 99.0) U/L, 143.3 (65.8, 256.5) ng/L, 356.8 (203.3, 528.4) μg/L in the pruritus group ( Z = -3.14, -3.96, -3.05, -2.88, -2.11, all P < 0.05). Increased hypersensitive C-reactive protein, brain natriuretic peptide, ferritin levels ( Wald = 14.58, 4.17, 4.23, all P < 0.05) were independent risk factors for uremic pruritus. Conclusion:Uremic pruritus remains a serious problem in patients undergoing hemodialysis. Increased hypersensitive C-reactive protein, ferritin, brain natriuretic peptide levels are independent risk factors for uremic pruritus. In clinical work, physicians should focus on strengthening the early identification of patients, optimizing treatment measures, and improving the quality of life of patients.
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Objective:To study the influences of different levels of hyperbilirubinemia on the myocardium of newborn rats.Methods:Ninety-six 7-day-old newborn SD rats were selected and randomly assigned into control group (n=32, intraperitoneal injection of normal saline 0.5 ml), test group 1 (n=32, intraperitoneal injection of bilirubin solution 100 mg/kg) and test group 2 (n=32, intraperitoneal injection of bilirubin solution 200 mg/kg). Four time points were set at 0 h, 8 h, 24 h and 48 h. The general conditions of 8 rats from every group at each time point were recorded. The total serum bilirubin (TSB), cardiac troponin I (cTnI),heart fatty acid-binding protein (H-FABP) and B-type natriuretic peptide (BNP) were examined. The heart was removed and the pathological changes of the myocardium were observed under microscope. The caspase-3, B-cell lymphoma-2 protein (bcl-2) and bcl-2-associated X protein (bax) were tested. Using SPSS 20.0 statistical software, two-way ANOVA analysis of variance was conducted.Results:The TSB in test group 1 and 2 at 8~48 h were 2.5~4.4 times and 3.5~7.4 times higher than at 0 h [(20.8±3.0~36.5±10.4) μmol/L and (31.9±12.3~67.4±19.0) μmol/L vs. (8.4±2.1) μmol/L and (9.1±2.9) μmol/L]. No significant changes existed in cardiac histopathology at each time point among the three groups. At 48 h, as TSB level increased, the expression of apoptosis-related proteins caspase-3 and bax increased and the expression of bcl-2 decreased. Significant differences existed in the protein levels between any two groups (all P<0.05), except that bcl-2 in test group 1 was similar to control group ( P=0.255). With the prolonged duration of hyperbilirubinemia in test group 2, the expression of caspase-3 and bax increased, while the expression of bcl-2 decreased. Statistically significant differences existed in the protein levels between any two time points (all P<0.05), except that bax in 8 h subgroup was similar to 12 h subgroup ( P=0.820), and bcl-2 in 8 h subgroup was similar to 0 h subgroup ( P=0.064). The cTnI at 8 h, 24 h and 48 h in test group 1 and 2 were all significantly higher than the control group (all P<0.05),however, no significant differences existed between test group 1 and 2 (all P>0.05). H-FABP and BNP showed no significant differences among the three groups at any time point (all P>0.05). Conclusions:Hyperbilirubinemia can induce apoptosis of myocardial cells in newborn rats in a concentration- and time-dependent manner. Hyperbilirubinemia shows no significant effects on cardiac tissue pathology. Hyperbilirubinemia may cause mild injury to myocardium of newborn rats. The injury shows no correlation with TSB level and BNP level was not influenced.
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Objective:To investigate the efficacy of ticagrelor combined with atorvastatin in the treatment of unstable angina pectoris and its effects on cardiac function, brain natriuretic peptide (BNP) level, lipoprotein-associated phospholipase A2 (Lp-PLA2) activity, and glycosylated hemoglobin (HbAlc) level in patients with unstable angina pectoris.Methods:A total of 200 patients with unstable angina pectoris who received treatment in the Sahzu International Medical Center from January 2017 to January 2019 were included in this study. These patients were randomly assigned to receive either clopidogrel combined with atorvastatin (control group, n = 100) or ticagrelor combined with atorvastatin (observation group, n = 100) for 1 month. The clinical efficacy,BNP level, Lp-PLA2 activity, HbAlc level, clinical symptom, cardiac function, and adverse reactions were compared between control and observation groups. Results:Effective rate was significantly higher in the observation group than in the control group [95% (95/100) vs. 75% (75/100), χ2 = 15.69, P < 0.001]. After treatment, BNP level and Lp-PLA2 activity in the observation group were (101.21 ± 40.13) ng/L and (105.56 ± 12.56) pg/L, respectively, which were significantly lower than those in the control group [(151.57 ± 37.29) ng/L, (137.52 ± 16.88) pg/L, t = 9.19, 15.19, P < 0.001]. After treatment, the duration and frequency of angina pectoris in the observation group were (1.84 ± 0.49) minutes/time and (1.32 ± 0.21) times/week, respectively, which were significantly lower than those in the control group [(5.23 ± 1.72) minutes/time and (3.58 ± 0.71) times/week, t = 18.95, 30.52, both P < 0.001]. After treatment, the left ventricular end-diastolic diameter and left ventricular end-systolic diameter in the observation group were (33.28 ± 1.21) mm and (47.89 ± 5.61) mm respectively, which were significantly lower than those in the control group [(37.56 ± 2.14) mm, (53.25 ± 5.07) mm, t = 17.41, 7.09, both P < 0.001]. Left ventricular ejection fraction was significantly higher in the observation group than in the control group [(48.59 ± 5.81)% vs. (41.16 ± 5.83)%, t = 9.03, P < 0.001]. The incidence of adverse reactions was significantly higher in the observation group than in the control group [1% (1/100) vs. 12% (12/100), χ2 = 9.96, P = 0.002]. Conclusion:Ticagrelor combined with atorvastatin is highly effective for unstable angina pectoris in coronary heart disease because it greatly decreases BNP level and Lp-PLA2 activity. Therefore, the combined therapy deserves clinical promotion.
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Objective:To evaluate the predictive value of the serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration for postoperative acute kidney injury (AKI) in neonates undergoing cardiac surgery.Methods:Perioperative data of 110 consecutive neonates (≤28 days) who underwent cardiac surgery in our hospital from October 2017 to May 2021, were collected retrospectively.According to pROCK criteria, the patients were divided into AKI group and non-AKI group.Demographics, predominant diagnosis, laboratory examination, perioperative management and postoperative outcomes were compared between two groups.The concentration of serum NT-proBNP was routinely measured within 12 h after operation.Multivariate logistic regression analysis was performed for the association between serum NT-proBNP and postoperative AKI.Receiver operating characteristic curve was drawn, and the predictive value of serum NT-proBNP for postoperative AKI was determined according to the area under the curve.Results:A total of 106 neonates were enrolled, and the incidence of postoperative AKI was 54.7%.There were significant difference in the baseline hemoglobin concentration, hematocrit and serum creatinine and serum NT-proBNP concentration between AKI group and non-AKI group ( P<0.05). Multivariate logistic regression analysis indicated that NT-proBNP level was an independent risk factor for AKI after cardiac surgery in neonates ( odds ratio 2.49, 95% confidence interval 1.183-5.23, P=0.016). The area under the curve of NT-proBNP predicting AKI after cardiac surgery was 0.66 (95% confidence interval 0.56-0.76, P=0.007). Conclusions:Elevated serum NT-proBNP concentration is an independent risk factor for AKI after cardiac surgery in neonates and has a certain predictive value for AKI, and close monitoring of perioperative NT-proBNP level is helpful for early identification of high-risk neonates.
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Objective:To investigate the effects of non-invasive positive pressure ventilation (NPPV) on plasma B-type natriuretic peptide (BNP) level and Tei index of right ventricle in preterm infants.Methods:Premature infants of gestational age<34 weeks with respiratory distress syndrome who were admitted in Neonatal Intensive Care Unit of Xuzhou Central Hospital and requiring for NPPV from December 2018 to October 2020, were enrolled in the study. Patients were randomly divided into two groups 46 patients received nasal continuous positive airway pressure ventilation (NCPAP group) and 49 patients received bi-level positive airway pressure ventilation (BiPAP group); 42 preterm infants of gestational age<34 weeks and without NPPV were selected as the control group. The plasma BNP, Tei index of right ventricle, mean airway pressure and oxygen index at 0-12 h and 48-60 h after NPPV were monitored in NCPAP group and BiPAP group. The plasma BNP and Tei index of right ventricle at 0-12 h and 48-60 h after admission were monitored in the control group. SPSS 20.0 statistical software was used for data analysis.Results:(1)The plasma BNP and Tei index of right ventricle at 48-60 h after NPPV were significantly higher than those at 0-12 h after NPPV in NCPAP group and BiPAP group [NCPAP group: (287.5±155.5) vs. (179.9±102.3) ng/L, (0.43±0.08) vs. (0.38±0.06); BiPAP group: (303.1±135.4) vs. (186.5±95.6) ng/L, (0.45±0.08) vs. (0.39±0.06); t=6.00, 3.34, 7.47, 4.48; all P<0.05]. There were no significant differences in the plasma BNP and Tei index of right ventricle at 48-60 h and 0-12 h after admission in the control group [(181.9±86.8) vs. (169.5±78.9) ng/L, (0.34±0.05) vs. (0.36±0.05); t=0.83, -1.59; all P>0.05].(2) There were no significant differences in the plasma BNP and Tei index of right ventricle at 48-60 h after NPPV between NCPAP group-and BiPAP group (all P>0.05), but they were significantly higher than those in control group at 48-60 h after admission(all P<0.05). (3)The mean airway pressure and oxygen index at 48-60 h after NPPV in NCPAP group and BiPAP group showed a decrease trend compared to those at 0-12 h after NPPV, but the differences were not significant [NCPAP group: (6.8±1.2) vs. (7.0±1.3) cmH 2O(1 cmH 2O=0.098 kPa), (5.7±2.1) vs. (6.1±2.3); BiPAP group: (7.0±1.3) vs. (7.2±1.2) cmH 2O, (5.5±2.0) vs. (5.8±2.1); t=-1.05, -0.80, -1.88, -0.67; all P>0.05]; while there were no significant differences between the two groups (all P>0.05). (4)There was a positive correlation between the plasma BNP and mean airway pressure ( r=0.48, P<0.001), but no correlation between Tei index of right ventricle and mean airway pressure ( r=0.17, P=0.119) at 48-60 h after NPPV. Conclusion:The cardiac function indexes such as plasma BNP and Tei index of right ventricle in preterm infants are increased at 48-60 h after NPPV. When mean airway pressure is the same, the effects of NCPAP and BiPAP on plasma BNP and Tei index of right ventricle in preterm infants are similar.
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Objective:To assess the effects of noninvasive positive pressure ventilation on premature infants' cardiac function using Tei index combined with corrected QT dispersion (QTcd) and B- type natriuretic peptide (BNP).Methods:This prospective study involved premature infants from 28 to 32 weeks of gestational age diagnosed with respiratory distress syndrome (RDS) and treated with noninvasive positive pressure ventilation in the Neonatal Intensive Care Unit of Xuzhou Central Hospital from December 2017 to December 2020. According to the mean airway pressure (MAP) during noninvasive positive pressure ventilation, the patients were divided into the low-pressure group (≤6 cmH 2O, 1 cmH 2O=0.098 kPa), medium-pressure group (>6-<9 cmH 2O), and high-pressure group (≥9 cmH 2O). The right ventricular Tei index, QTcd, and blood BNP were monitored during the first 2 h of noninvasive positive pressure ventilation and 12 h after continuous ventilation with stable MAP. Chi-square test, one-way analysis of variance, paired t-test, and Pearson product-moment correlation coefficient were adopted for statistical analysis. Results:Totally 178 premature infants were enrolled, including 75 in the low-pressure, 62 in the medium-pressure, and 41 in the high-pressure group. After continuous ventilation with stable MAP for 12 h, the right ventricle Tei index and QTcd in the high-pressure group were higher than those in the medium- and low-pressure group [Tei index: (0.38±0.05) vs (0.33±0.04) and (0.33±0.04), F=29.18; QTcd: (27.6±4.2) vs (22.8±4.4) and (22.2±4.2) ms, F=23.26, all P<0.001], and the comparison between the medium- and the low-pressure group did not differ significantly. No significant difference was observed in blood BNP levels among the three groups ( F=1.33, P=0.267). The right ventricle Tei index and QTcd increased in the high-pressure group after continuous ventilation with stable MAP for 12 h as compared with those within the first 2 h of noninvasive positive pressure ventilation [Tei index: (0.38±0.05) vs (0.34±0.04), t=－6.61; QTcd: (27.6±4.2) vs (23.4±4.4) ms, t=－5.06, all P<0.001]. However, the figures did not change significantly in the medium- or the low-pressure group (all P>0.05). There were no significant changes in blood BNP in the three groups (all P>0.05). The right ventricle Tei index and QTcd were moderately positively correlated with MAP ( r=0.56 and 0.50, both P<0.001). Conclusions:For the premature infants with RDS, noninvasive positive pressure ventilation has no significant effect on the cardiac function when MAP is less than 9 cmH 2O, but would have a certain effect on the right ventricular function when used at higher pressure (MAP≥9 cmH 2O) and for longer time (>12 h).
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Objective:To investigate myocardial fibrosis-related factors in patients with hypertrophic cardiomyopathy.Methods:Ninety-six patients with hypertrophic cardiomyopathy who received treatment in Zhoushan Hospital between January 2019 and January 2021 were included in this study. General data of all patients were collected. Cardiovascular magnetic resonance imaging was performed in all patients. Percentage of late gadolinium enhancement (LGE) was calculated. These patients were divided into positive and negative groups according to whether myocardial fibrosis existed. Related parameters were compared between the two groups. Correlations between related parameters and myocardial fibrosis range were analyzed.Results:Patient age in the positive group was significantly lower than that in the negative group [(42.84 ± 14.38) years vs. (50.71 ± 14.74) years, t = 2.04, P < 0.05]. The percentage of patients with New York Heart Association (NYHA) class III/IV heart function, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, cardiac troponin (cTnI) level, creatine kinase-MB level, and myoglobin level in the positive group were 29.41% (20/68), 2 761.73 (1 505.22, 3 784.62) ng/L, 0.971 (0.447, 1.687) μg/L, (3.25 ± 2.65) μg/L and (66.14 ± 31.17) μg/L, respectively, which were significantly higher than those in the negative group [3.57% (1/68), 862.35 (551.48, 1 094.83) ng/L, 0.146 (0.037, 0.256) μg/L, (0.73 ± 0.22) μg/L, (28.82 ± 2.34) μg/L, t = 12.17, 55.28, 3.17, 5.18, 8.18, all P < 0.05]. Left ventricular ejection fraction and cardiac index in the positive group were (62.31 ± 17.89)% and (2.85 ± 0.71) L·min -1·(m 2) -1, respectively, which were significantly lower than those in the negative group ( t = 2.89, 6.18, both P < 0.05). Left ventricular end-diastolic volume (LVEDV), left ventricular maximum wall thickness (LVMWT) and left ventricular mass index (LVMI) in the positive group were (56.32 ± 17.28) mL/m 2, (2.24 ± 0.41) cm, (126.15 ± 12.34) g/m 2, which were significantly higher than those in the negative group ( t = 2.17, 2.75, 13.10, all P < 0.05). In the positive group, 18 patients had moderate and severe hypertrophy, 20 patients had moderate hypertrophy, and 30 patients had mild hypertrophy. There were significant differences in NT-proBNP, cTnI level and (LGE) extent between positive and negative groups ( t = 43.27, 5.28, 11.18, all P < 0.05). NT-proBNP, cTnI level and LGE extent increased with the increase in hypertrophy. Percentage of LGE was negatively correlated with patient age, and it was positively correlated with NT-proBNP, cTnI, LVDSV, LVMWT and LVMI. The differences were statistically significant (all P < 0.05). Conclusion:Patients with hypertrophic cardiomyopathy have a relatively high incidence of myocardial fibrosis. The extent of myocardial fibrosis is negatively correlated with patient age and it is positively correlated with NT-proBNP, cTnI, LVDSV, LVMWT and LVMI.