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Objective:The 97.5th percentile upper reference limit (97.5th URL) of N-terminal prob-type natriuretic peptide (NT-proBNP) is influenced by multiple factors and depends on the inclusion criteria of apparently healthy people. In this study, the reference upper limit of NT-proBNP was established on apparently healthy people in Beijing area with abnormal hs-cTn as the exclusion criterion.Methods:According to the latest expert consensus recommendation standards of natriuretic peptide in the detection and clinical application of heart failure published by the Clinical Application Group of Cardiac Bio-Markers of the International Union of Clinical Chemistry, 1 635 healthy people without abnormal appearance of routine indicators such as sex, age, glycated hemoglobin, estimated glomerular filtration rate and medical history were collected. After excluding participants with potential myocardial injury according to hs-cTnI and/or hs-cTnT concentration>99th URL, NT-proBNP 97.5th URL was established in healthy subjects aged 21-40 years ( n=205), 41-50 years ( n=535), 51-60 years ( n=556) and >60 years ( n=339) based on non-parametric statistics. Results:The level of NT-proBNP was positively correlated with age ( r=0.254, P<0.001). The levels of NT-proBNP were positively correlated with hs-cTnI, hs-cTnT in males ( r=0.377 and r=0.429, both P<0.001). The levels of NT-proBNP were also positively correlated with hs-cTnI, hs-cTnT in females ( r=0.132 and r=0.296, both P<0.001). When hs-cTn>99th URL was used as the criterion to exclude patients with potential myocardial injury, among apparently healthy people aged 21-40 years old, 41-50 years old, 51-60 years old and >60 years old, male NT-proBNP 97.5th URL was 81.9 (90% CI 60.0-588.8), 141.2 (90% CI 100.0-263.6), 272.0 (90% CI 193.0-494.0) and 547.9 (90% CI 311.2-738.6), respectively; For females, the rates were 227.5 (90% CI 81.9-360.8), 153.2 (90% CI 128.2-239.5), 300.6 (90% CI 211.0-376.4) and 395.8 (90% CI 242.3-543.5) ng/L, respectively. Conclusions:This study confirmed that hs-cTn>99th URL can be used as an apparent population screening criterion for natriuretic peptide reference interval studies, which is helpful to remove conventional means to include individuals with occult myocardial injury in apparently healthy patients, so as to establish a more rigorous healthy cohort and establishing solid normal NT-proBNP reference interval.
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Objective:To analyze the effects of different plasma B-type natriuretic peptide (BNP) changes on worsening renal function (WRF) on 1-year all-cause mortality in patients with acute heart failure (AHF).Methods:The clinical data of 399 patients with AHF admitted to our hospital from January 2015 to December 2019 were retrospectively analyzed. According to the severity of WRF, the patients were divided into non-severe worsening renal function (nsWRF) group, severe worsening renal function (sWRF) group and non-WRF group. Plasma BNP decrease was defined as a reduction of B-type natriuretic peptide (BNP) at the time of discharge by ≥30% compared with the time of admission.Demographic characteristics and medical history, clinical data at admission, during hospitalization and at discharge, and survival status 1 year after discharge were collected. The measurement data presented in the form of normal distribution are as follows: single factor analysis of variance is used for comparison between groups, and LSD- t test is used for comparison between pairs; The Kruskal Wallis rank sum test was used for the multi group comparison of non normal distribution measurement data, and Wilcoxon rank sum test was used for the pairwise comparison. The comparison of counting data between groups was conducted using χ 2 test. Survival analysis was conducted using the Kaplan Meier method and Log rank test, and the Cox proportional risk regression model was used to analyze the influencing factors of 1-year all-cause mortality in patients. Results:399 cases of AHF were divided into nsWRF group with 68 cases, sWRF group with 82 cases, and nWRF group with 249 cases. 86 cases (21.5%) died within 1 year after discharge. The one-year mortality rate of the sWRF group was higher than that of the nWRF group and nsWRF group [42.7% (35/82) vs 16.1% (40/249), 16.2% (11/68)], and the differences were statistically significant (The χ 2 values were 24.94 and 12.28 respectively, both P<0.001), while there was no statistically significant difference between the nWRF group and the nsWRF group (χ 2=0.00、 P=0.982). The 1-year mortality rate of the nWRF group and sWRF group with decreased BNP during hospitalization was lower than that of the non decreased BNP group [29.1% (6/55) vs 70.4% (19/27), 10.5% (17/162) vs 26.4% (23/87), The χ 2 values are 12.61 and 10.67 respectively, and the P values are <0.001 and 0.001, respectively. The occurrence of nsWRF during hospitalization did not increase the one-year all-cause mortality risk of AHF patients ( P=0.754), but the occurrence of sWRF increased the all-cause mortality risk of AHF patients (odds ratio=2.33, 95% confidence interval: 1.31-4.13, P=0.004). The decrease in BNP during hospitalization reduced the one-year all-cause mortality risk of AHF patients (odds ratio=0.36, 95% confidence interval: 0.23-0.55, P<0.001). Conclusions:NsWRF does not increase the one-year all-cause mortality risk of AHF patients, while sWRF increases the one-year all-cause mortality risk, and a decrease in BNP during hospitalization reduces the one-year all-cause mortality risk.
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Objective:To study the clinical value of N-terminal pro-B-type natriuretic peptide (NTproBNP) predicting the risk of bronchopulmonary dysplasia (BPD) in very/extremely low birth weight infants (VLBWI/ELBWI).Methods:From June 2017 to December 2019, VLBWI/ELBWI admitted to neonatal department in our hospital were enrolled in this non-interventional prospective study. According to the occurrence of BPD, the infants were assigned into BPD group and non-BPD group. Infants in BPD group were further assigned into mild, moderate and severe BPD groups. Plasma NTproBNP were measured on 14 d, 21 d, 28 d, 35 d, 42 d and 49 d after birth. Repeated-measures ANOVA was used to determine the differences of NTproBNP at different time points in each group.Results:A total of 190 infants were enrolled, including 36 cases in BPD group (18, 13 and 5 cases in mild, moderate and severe BPD group, respectively) and 154 cases in non-BPD group. The gestational age, birth weight and 5-min Apgar score in BPD group were lower than non-BPD group. BPD group had significantly higher incidences of retinopathy of prematurity, patent ductus arteriosus and necrotizing enterocolitis and significantly longer duration of invasive mechanical ventilation and noninvasive ventilation than non-BPD group ( P<0.05).No significant differences existed in NTproBNP levels between BPD group and non-BPD group on 42 d and 49 d ( P>0.05). At other time points, NTproBNP levels in BPD group were significantly higher than non-BPD group ( P<0.05). NTproBNP level in severe BPD group was the highest on 14 d. No significant differences existed in NTproBNP levels between mild and moderate groups on 28 d ( P>0.05). At other time points, NTproBNP in severe BPD group was higher than mild and moderate BPD groups ( P<0.001). The receiver operating characteristic curve analysis showed the best cut-off value of NTproBNP was 982 pg/ml on 14 d (AUC=0.907, 95% CI 0.831~0.983). Conclusions:VLBWI/ELBWI with BPD have higher levels of NTproBNP. And the more severe of BPD, the higher the NTproBNP level. NTproBNP has certain predictive values for BPD in VLBWI/ELBWI.
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Resumen Introducción: El ecocardiograma es el método de referencia para el diagnóstico del conducto arterioso permeable (CAP) hemodinámicamente significativo (CAP-hs) del recién nacido prematuro (RNP). El péptido natriurético tipo B (BNP) puede ser útil en el diagnóstico y el manejo del CAP-hs. Objetivo: Evaluar la utilidad del BNP como marcador de sobrecarga hemodinámica del conducto arterioso permeable en el RNP con edad gestacional < 32 semanas o peso < 1500 gramos, e identificar el mejor punto de corte para los valores de BNP que mejor prediga un CAP con repercusión hemodinámica que requiera tratamiento farmacológico o quirúrgico. Método: Estudio retrospectivo, observacional y descriptivo de RNP < 32 semanas de gestación o peso < 1500 gramos en los que se realizó ecocardiograma y determinación del BNP. Análisis de muestra global y por subgrupos, en función del CAP-hs. Resultados: Se analizaron 29 pacientes. Se encontró una correlación significativa entre la relación CAP/peso y los valores del BNP (prueba de Spearman: 0.71; intervalo de confianza del 95%: 0.45-0.87; p < 0.001). El mejor punto de corte del BNP para predecir CAP-hs fue 486.5 pg/ml, con una sensibilidad del 81% y una especificidad del 92% (p < 0.001). Conclusión: El punto de corte del BNP identificado en el presente estudio se correlacionó con la presencia de CAP-hs.
Abstract Introduction: The echocardiogram is the gold standard, in the diagnosis of the hemodynamically significant patent ductus arteriosus (hs-PDA) of the premature newborn (PNB). Type B natriuretic peptide (BNP) may be useful in the diagnosis and management of CAP-hs. Objective: To assess the utility of BNP as a marker of hemodynamic overload of the patent ductus arteriosus in newborns with gestational age < 32 weeks or weight < 1500 grams, and to identify the best cut-off point for BNP levels that would best predict a PDA with hemodynamic impact requiring pharmacological and/or surgical treatment. Methods: Retrospective, observational and descriptive study of PNB < 32 weeks gestation or weight < 1500 grams, in which echocardiogram and BNP determination was performed. Analysis of the global sample and by subgroups, depending on the hs-PDA status was performed. Results: A total of 29 patients were analyzed. A significant correlation was found between the PDA/weight ratio and BNP levels (Spearman: 0.71; 95% confidence interval: 0.45-0.87; p < 0.001). The best BNP cut-off point to predict CAP-hs was 486.5 pg/ml with a sensitivity of 81% and specificity of 92% (p < 0.001). Conclusion: The BNP cut-off point identified in the present study was correlated with the presence of CAP-hs.
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Humans , Male , Female , Infant, Newborn , Natriuretic Peptide, Brain/blood , Ductus Arteriosus, Patent/physiopathology , Ductus Arteriosus, Patent/blood , Hemodynamics , Infant, Premature , Biomarkers/blood , Retrospective StudiesABSTRACT
Objective:To evaluate the effect of Jianxin-Pinglyu Pills combined with routine western medicine therapy on the patients with diabetes mellitus and ventricular arrhythmia (VA). Methods:A total of 92 patients with type 2 diabetes mellitus (T2DM) and VA who met inclusion criteria and treated in the hospital were enrolled between June 2019 and December 2020. According to random number table method, they were divided into observation group ( Jianxin-Pinglyu Pills on basis of control group) and control group (routine treatment), 46 cases in each group. Both groups were continuously treated for 2 months. Before and after treatment, TCM symptoms (chest pain and palpitation, chest distress and shortness of breath, dry mouth and thirst, fatigue) were scored. The fingertip blood was collected to detect levels of fasting blood glucose and 2 hPG. The 24 h dynamic electrocardiogram examination was conducted by electrocardiograph. The standard deviation of NN intervals (SDNN), standard deviation average of NN intervals (SDANN), the root mean square of successive R-R interval (RMSSD) and the percentage of adjacent NN intervals over 50 ms (PNN50) were statistically analyzed. The creatine kinase (CK) and creatine kinase isoenzymes (CK-MB) were detected by biochemical analyzer. The plasma brain natriuretic peptide (BNP) were detected by chemiluminescence immunoassay. The adverse reactions were recorded, and clinical curative effect was evaluated. Results:The differences in total response rate between observation group and control group were statistically significant [93.5% (43/46) vs. 78.3% (36/46); χ2=4.390, P=0.036]. After treatment, TCM symptoms (chest pain and palpitation, chest distress and shortness of breath, dry mouth and thirst, fatigue) in observation group were significantly lower than those in control group ( t=4.319, 2.714, 3.196, 4.667, P<0.01 or P<0.05), levels of fasting blood glucose and 2 hPG were significantly lower than those in control group ( t=2.025, 6.462, P<0.05 or P<0.01). After treatment, SDNN [(119.72 ± 5.86) ms vs. (115.27 ± 6.10) ms, t=3.568], SDANN [(112.80 ± 13.36) ms vs. (98.62 ± 14.51) ms, t=4.876], RMSSD [(46.87 ± 5.44) ms vs. (42.58 ± 5.73) ms, t=3.683] and PNN50 [(6.84 ± 0.66)% vs. (6.21 ± 0.64)%, t=4.648] in observation group were significantly higher than those in control group ( P<0.01), while the levels of CK [(263.82 ± 52.18) U/L vs. (306.59 ± 48.45) U/L, t=4.074] and CK-MB [(2.02 ± 0.62) g/L vs. (3.25 ± 0.49) g/L, t=10.556] were significantly lower than those in control group ( P<0.01), and level of plasma BNP [(126.99 ± 49.02) ng/L vs. (188.26 ± 54.30) ng/L, t=5.681] was significantly lower than that of control group ( P<0.01). During treatment, difference in incidence of adverse reactions between observation group and control group was not statistically significant [10.9% (5/46) vs. 4.3% (2/46); χ2 =0.619, P=0.432) ]. Conclusion:Jianxin-Pinglyu Pills combined with routine western medicine can effectively relieve clinical symptoms in patients with T2DM and VA, control hyperglycemia, improve heart rate variability, control levels of myocardial enzymes and plasma BNP, and safety.
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Objective To study the correlation of B-type natriuretic peptide(BNP)level with hemodynamic parameters and inflammatory cytokines in patients with Gram-negative sepsis,and further determine the main factors for the significant increase of BNP level. Methods The prospective study method was applied,and septic patients infected with Gram-negative bacteria from May 2017 to October 2019 were enrolled.The patients were divided into the BNP<2400 ng/L group and the BNP≥2400 ng/L group by taking the average value of BNP as the dividing point.The independent predictors of BNP≥2400 ng/L were analyzed by Logistic regression.Pearson correlation analysis was used to analyze the correlation between BNP and various indicators. Results A total of 106 patients with Gram-negative sepsis were included,among which 60 cases present with higher serum BNP levels than the average of(2398.45 ± 421.45)ng/L.Thus BNP≥2400 ng/L was considered as a significantly increased BNP level.Multiple logistic regression analysis showed that cardiac index(CI)[odds ratio (
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Humans , Cytokines , Gram-Negative Bacterial Infections , Hemodynamics , Natriuretic Peptide, Brain , Prognosis , Prospective Studies , Sepsis , Stroke Volume , Ventricular Function, LeftABSTRACT
Background: Acute heart failure (AHF) is a common and growing medical problem associated with major morbidity and mortality. It is the leading reason for hospital admission among patients over age 65 years. Not much of data is available from India, there are a lot of differences between the western data and available Indian data. Prompt diagnosis, identification of reversible causes and supportive management in ICU is of paramount importance.Methods: This study was conducted at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka after the institutional ethics committee approval. Those patients who were diagnosed to have AHF, were evaluated and treated as per the institution protocols in ICU and standard medical care which includes diuretics, inotropes and vasopressors. All the patients were prospectively studied; investigated for the etiology of AHF.Results: Majority of patients presenting as Acute Heart Failure are of 60 years mean age, with 63% males. Ischemic heart disease is the leading cause of Acute Heart Failure. Shortness of breath was the commonest presentation followed by crackles. Abdominal pain was the most common (28%) non cardiac symptom. There is no significant correlation between the presence of anemia and mortality. Hyponatremia had relation with mortality. 22% had HFpEF, rest had HFrEF. The mean hospital stay was 8.3 days. The study mortality was 9 % and the 30-day mortality was 13 % in our study.Conclusions: Current available data from Indian studies and registries has a lot of difference from the western data with regards to causes, response to treatment, and more such data is needed to frame regional guidelines for better understanding of presentation of heart failure ,treatment and risk factors for mortality.
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@#Although cardiovascular disease (CVD) is a major health challenge in Malaysia, many Malaysians are unaware of their CVD risk. The measurement of biomarkers in the general population may help to identify at-risk individuals before the onset of symptomatic CVD. The aim of this community health screening project was to determine the distribution of high-sensitivity troponin I (hsTnI) and other biomarkers of CVD risk in the general population of Johor, Malaysia. A sampling of self-declared healthy volunteers was conducted during the 2016 Kembara Mahkota community event in Johor. Levels of hsTnI, B-type natriuretic peptide (BNP) and homocysteine (HCY) were analyzed using the ARCHITECT immunoassay and clinical chemistry platforms utilizing fresh venous blood samples. Based on previous data, biomarker levels indicative of high risk were >10 and >12 ng/mL for hsTnI in women and men, respectively, BNP >50 pg/mL in the overall population, and HCY >13.6 µmol/L in women and >16.2 µmol/L in men. A total of 2744 volunteers participated in biomarker testing. Biomarker measurements showed that up to 10% of participants had moderate or high CVD risk based on hsTnI, approximately 2% were above the BNP threshold and >50% of subjects were above the HCY threshold. General population biomarker testing shows distribution of biomarker levels that may be indicative of CVD risk or the presence of disease and suggests that biomarker-guided risk strategies should be more widely implemented to determine the impact they would have on early detection and prevention of disease.
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Objective@#To evaluate the relationships between admission fasting serum C-peptide concentration and cardiac function status in chronic heart failure (CHF) patients with or without diabetes.@*Methods@#From July 2017 to December 2018, 262 CHF patients with or without diabetes in the Department of Cardiology of Pudong hospital in Shanghai were analyzed.Their cardiac function was classified as New York Heart Association (NYHA) grade Ⅱ to Ⅳ, and they were divided into diabetes group (80 cases) and non diabetes group (182 cases). At the same time, 62 subjects without diabetes and heart disease were randomly selected as the control group.To analyze the relationship between fasting serum C-peptide level and cardiac function in diabetic and nondiabetic CHF patients.@*Results@#(1)The fasting plasma glucose and serum C-peptide concentrations of diabetes group paitents were(8.7±2.9) mmol/L and(0.78±0.67) nmol/L respectively, the nondiabetes group paitents were(5.8±1.67) mmol/L and(0.56±0.61)nmol/L respectively, the control group were(5.1±0.69) mmol/L and(0.16±0.12)nmol/L respectively.The difference in the three groups was statistically significant(all P<0.001). The levels of fasting blood glucose and serum C-peptide in diabetic group were significantly higher than those in non diabetic group and control group (all P<0.01). The levels of fasting blood glucose and serum C-peptide in non diabetic group were significantly higher than those in control group (P<0.05 or P<0.01). The left ventricular ejection fraction (LVEF) in diabetic group was(44.1±8.3)%, and those in non diabetic group and control group were(46.7±7.2)% and(64.8±3.8)%.The difference in the three groups was statistically significant(<0.001). The LVEF of diabetic group was significantly lower than that of non diabetic group and control group (all P<0.01), and the CRP of diabetic group was (1.39±0.91) mg/L, the N-terminal pro-B-type natriuretic peptide (pro-BNP) was (1 771.3±23.1) ng/L, the hemoglobin was (125.6±16.7) g/L in the diabetic group, and (1.22±0.73) mg/L, (1 659.2±19.3) ng/L, (126.1±16.5) g/L in the non diabetic group, respectively, and (0.85±0.72) mg/L, (87.2±17.2) ng/L, (136.4±15.2) g/L in the control group, respectively.The differences among the three groups were statistically significant (P<0.001). CRP and pro-BNP in the diabetic group and non diabetic group were significantly higher than those in the control group (all P<0.01), and hemoglobin levels were significantly lower than those in the control group(all P<0.01). There were no statistically significant differences in CRP, pro-BNP and hemoglobin between the diabetic group and non diabetic group (all P>0.05). (2) In all patients with heart failure, diabetes mellitus and non diabetes heart failure, the levels of serum C-peptide were (1.05±0.85), (1.17±0.82), (0.99±0.86) nmol/L in NYHA Ⅳ group, and (0.53±0.22), (0.52±0.20), (0.54±0.23) nmol/L in NYHA Ⅲ group, and (0.32±0.09), (0.32±0.11), (0.31±0.09) nmol/L in NYHA Ⅱ group.After adjustment of age, gender, smoking, insulin secretion and hypoglycemic drugs, body mass index, blood pressure, total bilirubin (TBIL), alanine aminotransferase (ALT), creatinine, blood glucose, blood lipid, white blood cell count (WBC) and hemoglobin level by covariance analysis, all patients with heart failure The level of serum C-peptide in NYHA Ⅳ group was significantly higher than that in Ⅲ group (all P<0.01) and Ⅱ group (all P<0.01). In all patients with heart failure and non diabetic heart failure, the level of serum C-peptide in NYHA Ⅲ group was significantly higher than that in Ⅱ group (all P<0.05). There was no significant difference in serum C-peptide between all patients with heart failure, diabetes mellitus and non diabetes heart failure (all P>0.05) (3) Using multiple linear regression analysis, the adjustment factors included age, gender, smoking, BMI, blood pressure, TBIL, alt, creatinine, blood glucose, blood lipid, WBC and hemoglobin levels.The results showed that the serum C-peptide level was positively correlated with pro-BNP in all patients with heart failure, diabetes and non diabetes heart failure (β: 0.006, 95%CI -0.016-0.028 , P=0.007; β: 0.117, 95%CI-0.042-0.277 , P=0.006; β: 0.411, 95%CI-0.149-0.971 , P=0.023), negatively correlated with LVEF(β: -0.122, 95%CI-0.285-0.041, P=0.004; β: -0.008, 95%CI-0.032-0.016, P=0.010; β: -0.065, 95%CI-0.139-0.011, P=0.036).@*Conclusion@#The level of fasting serum C-peptide was significantly increased in patients with CHF and non-diabetic patients, and was related to the severity of heart failure.
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Objective: To investigate the predictive value of N-terminal type B natriuretic peptide（NT-proBNP) on the prognosis of elderly hospitalized patients without heart failure（non-heart failure). Method: Elderly patients aged 65 years or older, who were admitted to Beijing Hospital from September 2018 to February 2019, were enrolled in this study. Patients with clinical diagnosis of heart failure or left ventricular ejection fraction（LVEF)<50% were excluded. The patients were divided into 2 groups based on the serum NT-proBNP level: low NT-proBNP group （<125 ng/L) and high NT-proBNP group（≥125 ng/L). Patients were followed up at 3, 6, and 12 months after enrollment, and the major adverse events were recorded. The composite endpoint events included all-cause mortality, readmission or Emergency Department visits. Cardiovascular events include death, readmission or emergency room treatment due to cardiogenic shock, myocardial infarction, angina pectoris, arrhythmia, heart failure or stroke/transient ischemic attack. Results: A total of 600 elderly patients with non-heart failure were included in the analysis. The average age was （74.9±6.5) years, including 304（50.7%) males. The median follow-up time was 344（265, 359) days. One hundred and seventy-eight（29.7%) composite endpoint events were recorded during the follow-up, 19（3.2%) patients died, and 12（2.0%) patients were lost to follow-up. There were 286(47.7%) cases in low NT-proBNP group and 314 cases（52.3%) in high NT-proBNP group. Patients were older, prevalence of atrial fibrillation and myocardial infarction was higher; MMSE scores and ADL scores, albumin and creatinine clearance rate were lower in high NT-proBNP group than in low NT-proBNP group（all P<0.05). At 1-year follow-up, the incidence of composite endpoint events was significantly higher in high NT-proBNP group than in low NT-proBNP group（33.4%（105/314) vs. 24.8%（71/286), P = 0.02). Cardiovascular events were more common in high NT-proBNP group than in low NT-proBNP group（17.5%（55/314) vs. 8.4%（24/286), P = 0.001). Kaplan-Meier survival analysis showed both composite endpoint events（Log-rank P=0.016) and cardiovascular events（Log-rank P=0.001) were higher in high NT-proBNP group than in low NT-proBNP group. All-cause mortality was also significantly higher in highNT-proBNP group than in lowNT-proBNP group（4.8%（15/314) vs. 1.4%（4/286), P = 0.020), and Kaplan-Meier survival analysis demonstrated borderline statistical significance（Log-rank P = 0.052). Cox proportional hazard regression analysis showed that after adjusting for age, sex, creatinine clearance rate, myocardial infarction, and atrial fibrillation, NT-proBNP remained as an independent risk factor for composite endpoint events（HR=1.376，95%CI 1.049-1.806, P=0.021), and cardiovascular events（HR=1.777, 95%CI 1.185-2.664, P=0.005), but not for all-cause mortality（P=0.206). Conclusions: NT-proBNP level at admission has important predictive value on rehospitalization and cardiovascular events for hospitalized elderly non-heart failure patients. NT-proBNP examination is helpful for risk stratification in this patient cohort.
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Aged , Aged, 80 and over , Humans , Male , Biomarkers , Heart Failure , Natriuretic Peptide, Brain , Peptide Fragments , Prognosis , Stroke Volume , Ventricular Function, LeftABSTRACT
Background@#Clinical assessment and treatment guidance for heart failure depends on a variety of biomarkers. The objective of this study was to investigate the prognostic predictive value of growth differentiation factor-15 (GDF-15) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in assessing hospitalized patients with acute heart failure (AHF).@*Methods@#In total, 260 patients who were admitted for AHF in the First Affiliated Hospital of Nanjing Medical University were enrolled from April 2012 to May 2016. Medical history and blood samples were collected within 24 h after the admission. The primary endpoint was the all-cause mortality within 1 year. The patients were divided into survival group and death group based on the endpoint. With established mortality risk factors and serum GDF-15 level, receiver-operator characteristic (ROC) analyses were performed. Cox regression analyses were used to further analyze the combination values of NT-proBNP and GDF-15.@*Results@#Baseline GDF-15 and NT-proBNP were significantly higher amongst deceased than those in survivors (P < 0.001). In ROC analyses, area under curve (AUC) for GDF-15 to predict 1-year mortality was 0.707 (95% confidence interval [CI]: 0.648–0.762, P < 0.001), and for NT-proBNP was 0.682 (95% CI: 0.622–0.738, P < 0.001). No statistically significant difference was found between the two markers (P = 0.650). Based on the optimal cut-offs (GDF-15: 4526.0 ng/L; NT-proBNP: 1978.0 ng/L), the combination of GDF-15 and NT-proBNP increased AUC for 1-year mortality prediction (AUC = 0.743, 95% CI: 0.685–0.795, P < 0.001).@*Conclusions@#GDF-15, as a prognostic marker in patients with AHF, is not inferior to NT-proBNP. Combining the two markers could provide an early recognition of high-risk patients and improve the prediction values of AHF long-term prognosis.@*Clinical trial registration@#ChiCTR-ONC-12001944, http://www.chictr.org.cn.
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Objective@#To explore the relationship between the expression of serum B-type natriuretic peptide(BNP) levels and cardiac function, heart failure(HF) in children with ventricular septal defect of congenital heart disease(CHD).@*Methods@#From October 2013 to July 2017, 150 children with ventricular septal defect of CHD who were treated in Yuncheng Central Hospital were selected, and they were divided into no HF group(n=40), mild HF group(n=46) and moderately severe HF group(n=64) according to the New York university pediatric heart failure index(NYU PHFI) evaluation standard.Meanwhile, 148 healthy children were selected as control group.The serum BNP levels, left ventricular ejection fraction(LVEF), left ventricular ejection fraction shortening rate(LVFS), left ventricular end diastolic diameter index(LVEDDI) and cardiac output index(CI) were measured in all subjects.The levels of BNP, LVFS, LVEF, LVEDDI and CI in the study group were compared with those in the control group.The levels of BNP, LVEF, LVFS, LVEDDI and CI in children with CHD ventricular septal defect were compared.The relationship between the level of BNP and LVEF, LVFS, LVEDDI and CI in patients with ventricular septal defect of CHD was analyzed.@*Results@#The serum level of BNP in the study group was (268.47±25.48)ng/L, the levels of LVEF, LVFS, LVEDDI and CI in the study group were (55.56±4.23)%, (27.96±2.74)%, (77.56±6.54)mm/m2, (3.35±0.41)L·min-1·(m2)-1, respectively.The serum level of BNP in the control group was (33.41±6.21)ng/L, and the levels of LVEF, LVFS, LVEDDI and CI in the control group were (65.43±5.12)%, (36.24±3.23)%, (57.32±5.31)mm/m2, (4.27±0.46)L·min-1·(m2)-1, respectively.The serum levels of BNP and LVEDDI in the study group were significantly higher than those in the control group(t=109.077, 29.306, all P<0.05), while the levels of LVEF, LVFS and CI in the study group were significantly lower than those in the control group(t=18.152, 23.875, 18.231, all P<0.05). With the increased severity of HF, the levels of BNP and LVEDDI were increased, while the levels of LVEF, LVFS and CI were gradually decreased(F=332.232, 245.400, all P<0.05). The level of serum BNP was negatively correlated with LVEF, LVFS, CI(r=-0.705, -0.692, -0.718, all P<0.05), but it was positively correlated with LVEDDI and HF(r=0.721, 0.735, all P<0.05).@*Conclusion@#The level of serum BNP in patients with ventricular septal defect of CHD is correlated with cardiac function indicators, and serum BNP is positively correlated with HF in children with ventricular septal defect of CHD, which plays an important role for the diagnosis, treatment and prognosis of HF.
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Objective@#To investigate the prognostic value of N-terminal B-type natriuretic peptide (NT-proBNP) on all-cause mortality in heart failure patients with preserved ejection fraction (HFpEF) at real world scenarios.@*Methods@#Patients who met the diagnostic criteria of HFpEF in the China National Heart Failure Registration Study (CN-HF) were divided into death and survival groups. The demographic data, physical examination, results of the first echocardiography, laboratory results at admission, complications, drug use and clinical outcomes were obtained from CN-HF. The univariate Cox proportional hazard model was used to screen the variates that might predict prognosis, and then the covariates with statistical significance were included in the multivariate Cox regression model to analyze the predictive value of baseline NT-proBNP on all-cause death. Spearman correlation analysis was used to evaluate the relationship between NT-proBNP and estimated glomerular filtration rate (eGFR), so as to further explore the predictive value of the interaction between renal dysfunction and NT-proBNP on death. Since NT-proBNP did not obey the binary normal distribution, it was expressed by the natural logarithm of NT-proBNP (LnNT-proBNP).@*Results@#A total of 1 846 HFpEF patients were enrolled in this study, with an average age of 71.5 years, 1 017 males(55.1%), median NT-proBNP 860 ng/L, and median eGFR 73.9 ml·min-1·1.73m-2. After a median follow-up of 34 months, 213 (11.5%) patients died. Patients in the death group were older, with higher NYHA classification Ⅲ-Ⅳ ratio, longer hospital stay, higher serum potassium and NT-proBNP level, prevalence of complications of diabetes mellitus, arrhythmia and atrial fibrillation, use of angiotensin receptor antagonist(ARB), mineralocorticoid receptor antagonists (MRA), diuretic and digoxin was significantly higher in death group than in survival group. Body mass index (BMI), diastolic blood pressure, left ventricular ejection fraction (LVEF), hemoglobin, serum cholesterol(TC), serum triglycerides (TG) and eGFR, and use of angiotensin converting enzyme inhibitors (ACEI), statins and aspirin were lower in death group than in survival group. Univariate Cox regression analysis showed that NT-proBNP was a predictor of all-cause death in HFpEF patients (HR=2.522, 95%CI 2.040-3.119, P<0.001). Multivariate Cox regression analysis showed that the elevated NT-proBNP remains as the independent predictor of all-cause death in patients with HFpEF (HR=1.230, 95%CI 1.049-1.442, P=0.011) after adjusting for age, BMI, diastolic blood pressure, LVEF, hemoglobin, serum potassium, serum sodium, TC, serum high-density lipoprotein cholesterol (HDL-C), TG, eGFR, atrial fibrillation, as well as the treatment of ACEI/ARB, MRA, diuretics and digoxin. Spearman correlation analysis showed that LnNT-proBNP was negatively correlated with eGFR (r=-0.361, P<0.001), but there was no interaction between NT-proBNP and renal dysfunction in predicting death in HFpEF patients (P>0.05).@*Conclusion@#The elevated level of NT-proBNP at admission is an independent predictor of all-cause mortality in HFpEF patients.
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Objective@#To determine the diagnosis value and therapy significance of peripheral blood N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in pneumoconiosis patients with chronic pulmonary heart disease (CPHD) .@*Methods@#A total of 22 pneumoconiosis complicated with CPHD (A group) , 20 pneumoconiosis complicated with coronary heart disease (B group) and 25 pneumoconiosis without heart disease (C group) were selected. The level of blood NT-proBNP was examined and analyzed in the three groups. We observed the difference blood level of NT-proBNP concentration between before and after of therapy in pneumoconiosis patients with CPHD. The optimal cutoff value of blood NT-proBNP was determined according to the principle of maximum Youden's index associated with clinical analysis.@*Results@#Blood NT-proBNP concentrations were 543.19±78.92, 1017.38±731.06, 109.56±57.46 pg/ml in three groups, respectively. Compared with C group, there was a significant increase in the blood levels of NT-proBNP in both A and B groups (P<0.05, P<0.01) , especially for B group. Compared with NT-proBNP 543.19±78.92 pg/ml before therapy, the153.34±58.40 pg/ml was significantly declined after therapy in B group (P<0.05) . The optional threshold for peripheral blood NT-proBNP level as a diagnostic indicator for pneumoconiosis complicated with CPHD was 450 pg/ml. The specificity and sensitivity of NT-proBNP were 95.46% and 54.17%, respectively.@*Conclusion@#Blood NT-proBNP level may be useful as a tool for monitoring the effect of pneumoconiosis patients with CPHD treatment with higher sensitivity in. Blood NT-proBNP cut-off >450 pg/ml should be applied in clinical practice as a valuable diagnostic prediction for pneumoconiosis patients with CPHD.
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Objective To observe the effects of recombinant human B-type natriuretic peptide (rhBNP) on cardiac function and heart rate variability (HRV) in patients with heart failure after acute myocardial infarction (AMI). Methods One hundred and twenty patients with heart failure after AMI admitted to the Department of Cardiology of Cangzhou Central Hospital of Hebei Province from January 2015 to January 2018 were enrolled. The patients were divided into a conventional treatment group and an rhBNP treatment group according to random number table method, with 60 cases in each group. The two groups were treated according to the AMI guidelines, the conventional treatment group received west medicine anti-myocardial ischemia and anti-heart failure treatment; the rhBNP treatment group received rhBNP on the basis of routine treatment; the first load dose was 2 μg/kg intravenous injection impact treatment, followed by maintaining dose 8.5 ng·kg-1·min-1 intravenous drip for 7 days. The changes of hypersensitivity C-reactive protein (hs-CRP), N-terminal B-type natriuretic peptide precursor (NT-proBNP), left ventricular ejection fraction (LVEF) and HRV index were observed before and after treatment in the two groups [HRV indexes including the changes of average normal RR interval standard deviation (SDNN), the average value of the normal RR interval standard deviation (SDANN), the root mean square (RMSSD) of the adjacent RR interval difference, and the percentage of adjacent RR interval difference > 50 ms (PNN50)]; the incidences of adverse reactions in the two groups were observed. Results After treatment, the levels of hs-CRP and NT-proBNP in the two groups were significantly lower than those before treatment (all P < 0.05). LVEF, SDNN, SDANN, RMSSD and PNN50 were higher than those before treatment, and the changes of the above indicators in the rhBNP treatment group were more significant than those in the conventional treatment group [hs-CRP (mg/L): 6.2±3.3 vs. 11.8±5.5, NT-proBNP (ng/L): 2.5±2.0 vs. 6.4±4.3, LVEF: 0.49±0.02 vs. 0.44±0.04, SDNN (ms): 93.3±18.1 vs. 79.1±16.0, SDANN (ms): 87.3±17.8 vs. 70.9±14.9, RMSSD: 30.3±11.0 vs. 23.8±10.4, PNN50: (15.9±7.3)% vs. (9.6±5.5)%, all P < 0.05]; No significant adverse reactions occurred during the treatment of the two groups. Conclusion rhBNP can significantly improve the heart function of patients with heart failure after AMI, reduce the levels of inflammatory response indicators and improve HRV;since its clinical efficacy is good, and its application safe, it is worthy to promote its clinical use.
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Objective To explore the relationship between the expression of serum B －type natriuretic peptide(BNP) levels and cardiac function,heart failure(HF) in children with ventricular septal defect of congenital heart disease(CHD).Methods From October 2013 to July 2017,150 children with ventricular septal defect of CHD who were treated in Yuncheng Central Hospital were selected ,and they were divided into no HF group (n＝40),mild HF group(n＝46) and moderately severe HF group ( n＝64) according to the New York university pediatric heart failure index(NYU PHFI) evaluation standard.Meanwhile,148 healthy children were selected as control group.The serum BNP levels,left ventricular ejection fraction (LVEF),left ventricular ejection fraction shortening rate (LVFS), left ventricular end diastolic diameter index (LVEDDI) and cardiac output index (CI) were measured in all subjects. The levels of BNP,LVFS,LVEF,LVEDDI and CI in the study group were compared with those in the control group. The levels of BNP,LVEF,LVFS,LVEDDI and CI in children with CHD ventricular septal defect were compared.The relationship between the level of BNP and LVEF ,LVFS,LVEDDI and CI in patients with ventricular septal defect of CHD was analyzed.Results The serum level of BNP in the study group was (268.47 ±25.48) ng／L,the levels of LVEF,LVFS,LVEDDI and CI in the study group were (55.56 ±4.23)%,(27.96 ±2.74)%,(77.56 ±6.54)mm／m2, (3.35 ±0.41) L· min－1·( m2 )－1 ,respectively.The serum level of BNP in the control group was (33.41 ± 6.21)ng／L,and the levels of LVEF,LVFS,LVEDDI and CI in the control group were (65.43 ±5.12)%,(36.24 ± 3.23)%,(57.32 ±5.31) mm／m2 ,(4.27 ±0.46)L· min－1·(m2 )－1 ,respectively.The serum levels of BNP and LVEDDI in the study group were significantly higher than those in the control group (t＝109.077,29.306,all P＜0.05),while the levels of LVEF,LVFS and CI in the study group were significantly lower than those in the control group(t＝18.152,23.875,18.231,all P＜0.05).With the increased severity of HF ,the levels of BNP and LVEDDI were increased,while the levels of LVEF,LVFS and CI were gradually decreased ( F＝332.232,245.400,all P＜0.05).The level of serum BNP was negatively correlated with LVEF ,LVFS,CI(r＝－0.705,－0.692,－0.718,all P＜0.05),but it was positively correlated with LVEDDI and HF (r＝0.721,0.735,all P＜0.05).Conclusion The level of serum BNP in patients with ventricular septal defect of CHD is correlated with cardiac function indicators ,and serum BNP is positively correlated with HF in children with ventricular septal defect of CHD ,which plays an important role for the diagnosis,treatment and prognosis of HF.
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Objective To understand the changes of the levels of serum cortisol,pro‐B‐type natri‐uretic peptide(Pro‐BNP) and interleukin‐6(IL‐6) in the critical stress children. Methods The experimental group enrolled the children with severe infection,polytrauma and cardiopulmonary resuscitation admitted in PICU of Children′s Hospital of Fudan University from May 2015 to December 2015. The children admitted to the surgical ward during the same period without trauma,infection,heart,kidney and adrenal diseases or dys‐function,and without a long history of glucocorticoid use were selected as the control group. According to the pediatric critical illness score(PCIS),the experimental group was divided into 3 subgroups:severe critically ill group(PCIS≤70,n＝17),critically ill group(PCIS 71‐89,n＝26),and non‐critically ill group( PCIS≥90,n＝15). What′s more,the experimental cases were divided into survival group (n＝39) and death group ( n＝19) according to the prognosis. On the day of admission and during the period with stable condition,the peripheral blood sample were collected to detect serum cortisol,Pro‐BNP and IL‐6. While the control cases were detected the same items on the day of admission or pre‐operation. Results The concentrations of serum cortisol,Pro‐BNP and IL‐6 on the day of admission in severe critically ill group,critically ill group and non‐critically ill group were higher than those in the period with stable condition (P<0. 05). The concentrations of serum cortisol, Pro‐BNP and IL‐6 on the day of admission in control group, non‐critically ill group, critically ill group and severe critically ill group increased in sequence (P<0. 05). While in stable condition, there were no statistically significant differences among severe critically ill group,critically ill group and non‐critically ill group( P >0. 05). The concentrations of Pro‐BNP and IL‐6 in death group were significantly higher than those in survival group(P<0. 05). While the level of cortisol showed no statistically significant difference between death group and survival group( P>0. 05). PCIS was negatively correlated with serum cortisol,Pro‐BNP and IL‐6 (r＝ －0. 571,－0. 661 and －0. 504,P<0. 05,respectively). Conclusion The levels of serum cortisol,Pro‐BNP and IL‐6 in critically ill children all significantly increase in acute critically ill period,which are all negatively correlated with PCIS. They can be used as the indicators of severity of ill‐ness. Pro‐BNP and IL‐6 also can be used as the indicators of the prognosis of disease.
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Kawasaki disease ( KD) is an acute febrile illness that preferentially affects children youn-ger than 5 years old and the primary cause of acquired heart disease during childhood. Coronary artery aneu-rysms ( CAA) is a serious complication of KD, leading to ischemic heart disease, myocardial infarction, and sudden cardiac death. Timely initiation of treatment with intravenous immunoglobulin ( IVIG) has reduced the incidence of CAA from 25％ to 4％. Nitrogen-terminal B-type natriuretic peptide ( NT-proBNP ) , originally used for the management of adults with heart disease, was shown to be useful in the diagnosis and management of patients with KD. NT-proBNP is released by cardiomyocytes in response to mechanical factors, such as the dilation of cardiac chambers, and to pro-inflammatory cytokines. Patients with KD have higher NT-proBNP at the time of diagnosis than febrile controls. Moreover, patients with resistance to IVIG treatment and CAA were found to have higher levels of NT-proBNP, suggesting a prognostic role. This review summarizes the signifi-cance of NT-proBNP in the diagnostic value of KD in recent years.
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Objective To study the early diagnostic value of high-sensitivity cardiac troponin Ⅰ(hs-cTnI) and soluble growth stimulating gene 2 protein (soluble suppression of tumorigenicity 2,sST2) in myocardial injury of acute organophosphorus pesticide poisoning (AOPP).Methods Totally 168 AOPP patients hospitalized from March 2014 to October 2018 were divided into the mild group (n=45),moderate group (n=55) and severe group (n=68).Another 30 healthy persons were served as the control group.The levels of cTnI,hs-cTnI,N-terminal B-type natriuretic peptide(NT-proBNP) and sST2 were detected at 4 h and 12 h after admission.SPSS 21.0 was used for statistical analysis.The measurement data were expressed by mean±standard deviation,two groups were compared by LSD-t test,and the multigroup comparison was made by single factor analysis of variance (ANOVA).The correlation analysis by Spearman correlation test (P＜0.05).Results At 1 h after admission,the hs-cTnI of AOPP patients with different degrees of poisoning was higher than that of control group,and that of severe group was higher than that of mild to moderate group.Comparison between groups was statistically significant (P＜0.05).However,there was no significant difference in the cTnI level (P＞0.05).At 4 h and 12 h after admission,the levels of cTnI and hs-cTnI increased with the increase of poisoning degree and the extension of time,and their level at 12 h after admission were significantly higher than those at 4 h after admission,with statistically significant difference between the two groups (P＜0.05).At 1 h after admission,the level of sST2 in the poisoned patients was higher than that in the control group,and the level in the severe group was higher than that in the mild to moderate groups.At 4 h and 12 h after admission,the level of sST2 was increased significantly,especially in the severe group.The level of sST2 at 12 h after admission was significantly higher than that at 4 h after admission (P＜0.05).The concentration of NT-proBNP was in normal range 1 h after admission,increased gradually at 12 h after admission,and the level of NT-proBNP in the severe group was significantly higher than that in the other groups (P＜0.05),and comparison between the groups was significantly different (P＜0.05).The correlation analysis showed that there was a positive correlation between hs-TnI and sST2 in AOPP patients (r=0.776,P＜0.01).hs-TnI and sST2 was positively correlated with the severity of AOPP (r=0.958,P＜0.01;r=0.844,P＜0.01).That is,the more severe the patient,the higher the concentration of hs-TnI and sST2,and the more serious myocardial injury.Conclusions Early detection ofhs-cTnI and sST2 levels in AOPP patients can identify early myocardial damage and objectively evaluate the extent of myocardial damage.
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Objective@#To determine the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) on predicting the long-term outcome of patients with hypertrophic cardiomyopathy (HCM) .@*Methods@#NT-proBNP was measured in 831 consecutive patients with HCM at Fuwai Hospital from October 2009 to December 2013 and patients were followed up clinically for (53.3±15.4) months. Patients were divided into 3 groups according to NT-proBNP values: NT-proBNP<860 pmol/L (n=276) , 860 pmol/L≤NT-proBNP≤1 905 pmol/L (n=278) , NT-proBNP>1 905 pmol/L (n=277) . The related baseline data, laboratory examination and echocardiographic results were compared among groups. The primary endpoints of this study were all-cause mortality and cardiac transplantation. Cox proportional hazards model was used to estimate hazard ratio (HR) . Kaplan-Meier analysis was used to evaluate the survival status of patients among the 3 groups.@*Results@#During a median follow-up of (53.3±15.4) months, all-cause mortality or cardiac transplantation occurred in 37 patients (4.5%) , event rate was 1.4% (4/276) , 4.0% (11/278) and 7.9% (22/277) in patients with NT-proBNP<860 pmol/L, 860 pmol/L≤NT-proBNP≤1 905 pmol/L and NT-proBNP>1 905 pmol/L, respectively. Multivariable Cox regression analysis identified that age (HR 1.066, 95%CI 1.027-1.107) and NT-proBNP (HR 1.026, 95% CI 1.010-1.042) were independent predictors of all-cause mortality or cardiac transplantation. Among the 3 groups, the survival rate of the NT-proBNP<860 pmol/L group was the highest,and that of the NT-proBNP>1 905 pmol/L group was the lowest (P<0.01) .@*Conclusions@#The level of NT-proBNP provides clinically relevant information for long-term adverse events risk stratification in patients with HCM.