Evaluation of Clinical, Demographic, and Biochemical Profiles of Trinidadian Patients Undergoing Coronary Angiography

Background: Trinidad and Tobago ranks number 45 in the world for total deaths due to coronary heart disease. Predictive tests for coronary angiographic results set the basis for earlier monitoring of the disease before additional complications become obvious. Aims and Methods?This study aimed to evaluate the anthropometric and biochemical parameters of 124 patients with suspected coronary artery disease (CAD) in Trinidad and how these parameters correlate to the findings at angiography. Results?The biochemical parameters showed statistically significant correlations with CAD severity by Spearman's rank-order correlation. Two clinical parameters showed significant associations with CAD severity—ethnicity (?2 (4)?=?12.925, p?=?0.012) and presence of type 2 diabetes at baseline (?2 (4)?=?21.483, p?<?0.001). Conclusion?Biochemical parameters such as fasting blood sugar, N-terminal pro B-type natriuretic peptide, creatinine, and hemoglobin A1c were well correlated and well associated with the severity of CAD after diagnosis by the process of coronary angiography. Hence, these factors can be taken into consideration to predict the severity of CAD.

El péptido Pro-BNP como predictor de daño cardíaco en pacientes con esclerosis sistémica / Pro-BNP Peptide as a Predictor of Cardiac Damage in Systemic Sclerosis Patients

Introducción: La esclerosis sistémica es una enfermedad crónica del tejido conectivo de carácter autoinmune, de causa desconocida, que produce exceso de colágeno provocando fibrosis en la piel, con afectación de órganos internos. Los anticuerpos frecuentes son: antitopoisomerasa 1 y anticentrómero. Las formas clínicas son la cutánea difusa y cutánea limitada. La prevalencia de la afectación cardíaca varía entre un 8-28 por ciento y en fases tardías la presencia de signos y síntomas cardiovasculares es de mal pronóstico y una de las principales causas de mortalidad. Objetivo: Determinar la asociación entre afectación cardíaca y las formas clínicas, el pro-péptido natriurético cerebral N-terminal (NT-proBNP) y los autoanticuerpos en la esclerosis sistémica. Métodos: Se realizó un estudio descriptivo transversal de un universo de 140 pacientes, la muestra fue de 54 pacientes. Se le realizó ecocardiograma, niveles de NT-proBNP, anti-scl 70, anticentrómero y determinación de formas clínicas a todos los pacientes que cumplieron criterios de inclusión y que fueron atendidos en el Hospital: Hermanos Ameijeiras Habana-Cuba, entre julio de 2016 a diciembre de 2017. Resultados: La edad media fue 51,76 ± 12,82. Sexo femenino en un 96,3 por ciento. El 72,2 por ciento era piel blanca. La afectación cardíaca de la EScd fue de 77,5 por ciento, hormona NT-proBNP tuvo niveles elevados en un 55,0 por ciento. Los anti-scl-70 estuvieron negativos en el 70 por ciento (n = 28) de los pacientes con afectación cardíaca. El anti-centrómero estuvo negativo en el 95,0 por ciento (n = 38). Conclusiones: Se determinó que la afectación cardíaca en pacientes con esclerosis sistémica, es independiente de las formas clínicas y de la presencia de autoanticuerpos. Los pacientes que tuvieron los niveles séricos de NT-proBNP elevados presentaron afectación cardíaca(AU)

Introduction: Systemic sclerosis is a chronic autoimmune connective tissue disease of unknown cause, which produces excess collagen causing fibrosis in the skin, affecting internal organs. Common antibodies are antitopoisomerase 1 and anticentromere. The clinical forms are diffuse cutaneous and limited cutaneous. The prevalence of cardiac involvement varies between 8-28percent and in late stages the presence of cardiovascular signs and symptoms have poor prognosis and one of the main causes of mortality. Objective: To determine the association between cardiac involvement and clinical forms, N-terminal pro-brain natriuretic peptide (NT-proBNP) and autoantibodies in SSc. Methods: A cross-sectional descriptive study of a universe of 140 patients was carried out. Fifty four patients made up the sample. An echocardiogram, NT-proBNP, Anti-scl 70, anticentromere levels and determination of clinical forms were performed on all patients who met the inclusion criteria and who were treated at Hermanos Ameijeiras hospital in Havana, Cuba, from July 2016 to December 2017. Results: The mean age was 51.76 ± 12.82. Female sex accounted 96.3percent. 72.2percent were white skinned. Cardiac involvement of EScd was 77.5percent, NT-proBNP hormone had high levels in 55.0percent. Anti-scl-70 were negative in 70percent (n=28) of patients with cardiac involvement. Anti-centromere (ACT) was negative in 95.0percent (n=38). Conclusions: Cardiac involvement in patients with SS is independent of the clinical forms and the presence of autoantibodies. Patients with elevated NT-proBNP serum levels had cardiac involvement(AU)

Uso de NT-proBNP en el seguimiento ambulatorio de pacientes con insuficiencia cardiaca con fracción de eyección del ventrículo izquierdo reducida en una unidad multidisciplinaria de insuficiencia cardiaca

Introducción: La insuficiencia cardíaca (IC) es un síndrome clínico prevalente a nivel mundial, que se beneficia del abordaje multidisciplinario, pero su seguimiento ambulatorio sigue siendo un reto. La utilidad diagnóstica y pronóstica del NT-proBNP está apoyada en la evidencia actual; pero su uso en el seguimiento aún no ha sido definido. En el presente estudio se busca determinar si la variación en el tiempo del valor de NT-proBNP se relacionó con modificación en el tratamiento farmacológico de pacientes ambulatorios con IC y fracción de eyección del ventrículo izquierdo reducida (FEVI ≤ 40%) de una unidad multidisciplinaria de insuficiencia cardíaca (UMIC). Metodología: Estudio cohorte retrospectivo, de pacientes que cumplieron con los criterios de inclusión: 2 o más cuantificaciones de NT-proBNP en 12 meses y un seguimiento mínimo de 2 años entre los años 2013 y 2017. Resultados: De un total de 566 sujetos integrantes de cohorte activa de UMIC se incluyeron 107 que cumplieron criterios de inclusión; la mayoría hombres (58%), edad mediana de 63 años (Q1;Q3: 55,9;71,2 años), la principal comorbilidad fue hipertensión arterial (71%). En 56% de la población la etiología de IC fue no isquémica y el 50% tenía una clase funcional - NYHA I. La mediana de NT-proBNP basal fue de 698 pg/ml (Q1;Q3: (218;1564 pg/ml), con FEVI basal mediana de 30% (Q1;Q3: 27%;40%). En 55% de los pacientes la variación del valor de NT-proBNP durante el seguimiento se relacionó con modificaciones en el tratamiento farmacológico. Conclusiones: En la mitad de la población de nuestra cohorte se evidenció que los valores de NT-proBNP se relacionaron con cambios en el tratamiento farmacológico, independientemente de la situación clínica.

Introduction: Heart failure (HF) is a prevalent clinical syndrome worldwide, which benefits from a multidisciplinary approach, but its outpatient follow-up remains a challenge. The diagnostic and prognostic utility of NT-proBNP is supported by current evidence, but its use in monitoring has not yet been defined. The present study sought to determine whether the variation over time in the value of NT-proBNP was related to changes in the pharmacological treatment of outpatients with HF and reduced left ventricular ejection fraction (LVEF ≤ 40%) in a multidisciplinary heart failure unit. (MHFU). Methodology: Retrospective cohort study of patients, who met the inclusion criteria: 2 or more quantifications of NT-proBNP in 12 months and a minimum follow-up of 2 years between 2013 and 2017. Results: Of 566 members of the MHFU active cohort, 107 met the inclusion criteria; most men (58%), median age 63 years (Q1;Q3: 55.9;71.2), the main comorbidity was arterial hypertension (71%). The etiology of HF was non-ischemic in 56% of the population, and 50% had a functional class - NYHA I. Median baseline NT-proBNP was 698 pg/ml (Q1;Q3: (218;1564), with median baseline LVEF of 30% (Q1;Q3: 27;40). In 55% of the patients, the variation in the NT-proBNP value during follow-up was related to changes in pharmacological treatment. Conclusions: In half of the population of our cohort, it was shown that NT-proBNP values were related to changes in pharmacological treatment, regardless of the clinical situation.

Introdução: A insuficiência cardíaca (IC) é uma síndrome clínica prevalente em todo o mundo, que se beneficia de uma abordagem multidisciplinar, mas seu acompanhamento ambulatorial continua sendo um desafio. A utilidade diagnóstica e prognóstica do NT-proBNP é suportada pelas evidências atuais, mas seu uso no monitoramento ainda não foi definido. O presente estudo procurou determinar se a variação ao longo do tempo no valor do NT-proBNP estava relacionada a mudanças no tratamento farmacológico de pacientes ambulatoriais com IC e fração de ejeção do ventrículo esquerdo (FEVE ≤ 40%) reduzida em uma unidade multidisciplinar de insuficiência cardíaca. (UMIC). Metodologia: Estudo de coorte retrospectivo de pacientes que preencheram os critérios de inclusão: 2 ou mais quantificações de NT-proBNP em 12 meses e seguimento mínimo de 2 anos entre 2013 e 2017. Resultados: Dos 566 membros da coorte ativa do UMIC, 107 preencheram os critérios de inclusão; maioria dos homens (58%), idade mediana 63 anos (Q1;Q3: 55,9;71,2), a principal comorbidade foi hipertensão arterial (71%). A etiologia da IC foi não-isquêmica em 56% da população, e 50% tinham classe funcional - NYHA I. A mediana basal do NT-proBNP foi de 698 pg/ml (Q1;Q3: (218;1564), com mediana basal FEVE de 30% (Q1;Q3: 27;40). Em 55% dos pacientes, a variação do valor de NT-proBNP durante o seguimento esteve relacionada a mudanças no tratamento farmacológico. Conclusões: Em metade da população do nosso coorte, foi demonstrado que os valores de NT-proBNP estavam relacionados a mudanças no tratamento farmacológico, independentemente da situação clínica.

2D Echocardiographic Findings, NT-ProBNP Levels, and Outcomes in Dyspnoeic Patients: Results from the Pro-BNP Investigation of Dyspnoea in the Emergency Department- a Single Centre Experience

Background: Dyspnoeic in the emergency department with multiple co-morbidities is a diagnostic challenge. Approximately 15-20% of acute dyspneic in the Emergency Department due to ADHF (acute decompensated heart failure) are misdiagnosed. B-type peptide (BNP) and its amino-terminal fragment (NT-proBNP) accurately identify HF in dyspnoeic patients. In the general population with dyspnoea, plasma pro-BNP concentrations are increased in left ventricular dilatation, hypertrophy, systolic dysfunction, or diastolic dysfunction but are unaffected by pulmonary dysfunction. Aims and Objectives: To study the relation between NT pro-BNP & echocardiographic findings in acute dyspnoeic patients, and the relation between NT pro-BNP and In-hospital Mortality. Materials and Methods: Source of data- Patients admitted to the Emergency Room or cardiac intensive care unit with a history of acute dyspnea in a tertiary cardiac care center in south India, meeting inclusion & exclusion criteria, were studied. Results: The study population is predominantly constituted of the elderly population. The most common co-morbid condition was hypertension. The present study uses an NT pro BNP level of 900pg/ml as the cut-off level. 78 patients were positive for the test. Echocardiography showed that 58% had LV systolic dysfunction, 60% had diastolic dysfunction. 42 patients had EF >55%, 10 patients between 55-45%, 33 patients between 44-30% and 15 patients had EF < 30%. Mortality rate was 6% in the whole study population. However, Mortality was seen in only NT pro-BNP positive group it was not statistically significant (p=0.46). Conclusions: NT pro-BNP correlates well with the worsening of LV systolic function; as the EF decreases, NT pro-BNP increases. Increase in NT pro-BNP levels has to be interpreted in the clinical context, and it is not a substitute for echocardiography for assessing cardiac abnormalities and dysfunction.

Clinical value of sST2 in replacement of NT-proBNP in cardiac function evaluation in renal failure patients after cardiac surgery / 中国胸心血管外科临床杂志

@#Objective    To explore the clinical value of soluble suppression of tumorigenesis-2 (sST2) in replacement of N-terminal fragment of the brain natriuretic peptide precursor (NT-proBNP) in cardiac function evaluation in renal failure patients after cardiac surgery. Methods    Sixty patients with renal insufficiency after cardiac surgery from January 2019 to June 2019 were divided into a test group, including 34 males and 26 females, with an average age of 49-78 (63.3±4.5) years. Another 60 patients with normal renal function were divided into a control group, including 37 males and 23 females, with an average age of 53-77 (61.7±3.8) years. The perioperative left ventricular ejection fraction, cardiac troponin T, creatine kinase-MB, sST2 and NT-proBNP were compared. Results    In patients of the test group, the NT-proBNP level increased significantly during perioperative period, and the change range was different from other cardiac function indexes. The change of sST2 in perioperative period was similar to other cardiac function indexes, which could reflect the change degree of cardiac function after operation. Conclusion    sST2 is more important to reflect the change degree of cardiac function in patients with renal dysfunction after cardiac surgery than NT-proBNP.

Urinary N-terminal pro-B-type natriuretic peptide as a biomarker for cardiovascular events in a general Japanese population: the Hisayama Study

BACKGROUND@#Epidemiological evidence has shown that serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, a diagnostic biomarker for heart failure, are positively associated with cardiovascular risk. Since NT-proBNP in serum is excreted in urine, it is hypothesized that urinary NT-proBNP concentrations are correlated with serum concentrations and linked with cardiovascular risk in the general population.@*METHODS@#A total of 3060 community-dwelling residents aged ≥ 40 years without history of cardiovascular disease (CVD) were followed up for a median of 8.3 years (2007-2015). Serum and urinary concentrations of NT-proBNP at baseline were compared. The hazard ratios (HRs) and their 95% confidence intervals (CIs) for the association between NT-proBNP concentrations and the risk of developing CVD were computed using the Cox proportional hazards model.@*RESULTS@#The median values (interquartile ranges) of serum and urinary NT-proBNP concentrations at baseline were 56 (32-104) pg/mL and 20 (18-25) pg/mL, respectively. There was a strong quadratic correlation between the serum and urinary concentrations of NT-proBNP (coefficient of determination [R@*CONCLUSIONS@#The present study demonstrated that urinary NT-proBNP concentrations were well-correlated with serum concentrations and were positively associated with cardiovascular risk. Given that urine sampling is noninvasive and does not require specially trained personnel, urinary NT-proBNP concentrations have the potential to be an easy and useful biomarker for detecting people at higher cardiovascular risk.

Association of N-terminal-Pro-B-type Natriuretic Peptide with Localization of Thrombus and Clinical Outcome in Acute Pulmonary Embolism

Introduction: Pulmonary Embolism is a major health problemwhich is associated with significant mortality and morbidity. Itis a common and lethal condition. This study was undertakento find the association between NT-Pro-BNP levels and thelocalisation of thrombus in acute Pulmonary Embolism and toprognosticate the patients.Material and methods: Prospective study conducted ata tertiary care hospital.Thirty patients with PulmonaryEmbolism of various etiologies, confirmed with clinicalfeatures, laboratory investigations and imaging and fulfillingthe inclusion and exclusion criteria were included. Aftergetting informed consent, Blood samples for assessmentof NT-Pro-BNP levels were collected within 24 hours ofadmission.Results: In 19 patients, the thrombus was located centrally(in main pulmonary artery) whereas in 11 patients, thethrombus was located in the peripherally (in segmental andsubsegmental pulmonary arteries). 22 participants of thestudy had normal clinical outcome. 5 patients were morbid(oxygen dependant/ heart failure) whereas 3 patients died.Patients with central pulmonary embolus had higher NT-ProBNP levels whereas patients with pulmonary embolus in thesegmental or subsegmental pulmonary arteries had relativelyless NTPro-BNP levels. Patients with high NT-Pro-BNPlevels had complicated in-hospital course/ mortality whereas,patients with relatively lower NT-Pro-BNP had uncomplicatedin-hospital course.Conclusion: This study shows that higher NT-Pro-BNPlevels indicate higher probability of a more central locationof thrombus in pulmonary embolism and also right ventricularoverload. Also patients with higher NT-Pro-BNP levels had acomplicated in hospital course.

A Study to Assess the Role of NT-proBNP as a Marker of Cardiac Mortality In Hemodialysis Patients

Background: Increased N-terminal pro-B-type natriureticpeptide (NT-proBNP) concentrations are associated withcardiovascular mortality in hemodialysis patients. The presentstudy was conducted to assess the role of NT-proBNP as amarker of cardiovascular mortality in hemodialysis patients.Materials and Methods: NT-proBNP concentrations weremeasured in 50 prevalent hemodialysis patients to examine therisk of 90-days and 1-year mortality associated with baselineNT-pro BNP concentrations. Data was analyzed usingstandard descriptive statistics. Wilcoxon signed rank test andWelch two sample t-test were used in “R” commanderstatistical software.Results: The NT –pro BNP values at the entry into the study ofshort term i.e.90 days follow up death group were significantly(p value = 0.002647) high when compared to remaining livedialysis participants (n = 40). But the difference in NT –proBNP values at the entry into the study between death and liveparticipants was not statistically significant (p value = 0.7785)in long term i.e.1 year follow up participants. The difference inserum sodium at the time of entry, is statistically significant (p =0.03564), between live and dead groups at the end of shortterm follow up.Conclusion: Elevated NT-proBNP concentrations wereobserved in end-stage renal disease (ESRD) patients ondialysis at the entry of study and these values were associatedwith cardiac mortality in them. NT –pro BNP acts as a newermarker for cardiovascular risk in dialysis patients of ESRD.

Lo mejor del Congreso Uruguayo de Cardiología 2018 / The best of the 2018 Uruguayan Congress of Cardiology / O melhor do Congresso Uruguaio de Cardiologia 2018

Resumen: El 34° Congreso Uruguayo de Cardiología, celebrado en Montevideo del 2 al 4 de diciembre del pasado año, nuevamente destacó por las excelentes presentaciones de los temas más relevantes del ámbito cardiológico, así como también por sus invitados de renombre, nacionales e internacionales. Acompañando el gran nivel del Congreso se expusieron 32 temas libres que abarcaron diferentes áreas de la cardiología de los cuales comentaremos cuatro trabajos premiados: - Riesgo de trombosis en bioprótesis aórtica y eventos clínicos según uso de anticoagulación. Metaanálisis de la evidencia actual. - Uso de NT-ProBNP como predictor de evolución en el posoperatorio de cirugía cardíaca. - Prevalencia de septal pouch en una cohorte derivada para ecocardiograma transesofágico. - Incidencia de troponina T ultrasensible en rango anormal y su correlación con la anatomía coronaria en pacientes en valoración por enfermedad coronaria estable.

Summary: The 34th Uruguayan Congress of Cardiology, celebrated last year in Montevideo from December 2nd to 4th, again stood out for the excellent presentations of the most relevant topics in the field of cardiology, as well as for its renowned national and international guests. Accompanying the great level of the Congress, 32 articles that covered different topics in the cardiological area were presented, of which we will comment four awarded: - Risk of thrombosis in aortic bioprosthesis and clinical events according to the use of anticoagulation. Meta-analysis of current evidence. - Use of NT-ProBNP as a predictor of evolution in the postoperative period of cardiac surgery. - Prevalence of septal pouch in a cohort derived for transesophageal echocardiography. - Incidence of ultrasensitive troponin T in abnormal range and its correlation with coronary anatomy in patients in assessment for stable coronary disease.

Resumo: O 34º Congresso Uruguaio de Cardiologia, realizado em Montevidéu entre os dias 2 e 4 de dezembro no ano passado, voltou a destacar-se pelas excelentes apresentações dos temas mais relevantes no campo da cardiologia, bem como por seus renomados convidados, nacionais e internacionais. Acompanhando o grande nível do Congresso, tinham 32 temas livres que cobriam diferentes áreas da cardiologia, dos quais comentaremos quatro artigos premiados: - Risco de trombose na bioprótese aórtica e eventos clínicos de acordo com o uso de anticoagulação. Meta-análise da evidência atual. - Uso de NT-ProBNP como preditor de evolução no pós-operatório de cirurgia cardíaca. - Prevalência de bolsa septal em uma coorte derivada para ecocardiografia transesofágica. - Incidência de troponina T ultrassensível em faixa anormal e sua correlação com a anatomia coronariana em pacientes em avaliação para doença coronariana estável.

To estimate the serum level of N-terminal pro-brain natriuretic peptide levels in acute coronary syndrome

Background: Acute coronary syndromes caused by a sudden blockage of a coronary artery. According to degree and location of the blockage, it ranges from unstable angina to non–STsegment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction (STEMI), and sudden cardiac death. The levels of serum cardiac markers get elevated during myocardial necrosis in ACS. B-type natriuretic peptide (BNP), cardiac neurohormone, and its Nterminal fragment (NT-proBNP) are synthesized and secreted from the ventricular myocardium. It is well known that the stimulus for their release is the increase in left ventricular wall stress. Aim and objectives: To estimate the serum level of N-terminal pro-Brain natriuretic peptide levels in acute coronary syndrome, to assess the levels of NT-pro-BNP and its relationship between STEMI, NSTEMI and Unstable angina patients. Materials and methods: The study included 40 patients admitted in the medicine ward of RMMCH. The study period was from January 2018- July 2018. Patients with acute coronary syndromes were identified over a period according to the criteria and were included in the study. The patients were completely evaluated and their serum NT-pro BNP levels were noted. Killips Class was recorded if the patient was in acute MI. In NSTEMI, STEMI and unstable angina, TIMI scoring was also calculated. Results: The common age of the patients was 51 to 60 years (50%). In the age group of 41 to 50 years, 30% was observed. In the age category of 31 to 40 years, 20% was observed. The mean age was 49.10 years. There was 55% of patients with NT pro BNP > 500 in the age category 51- 60 years whereas only 16.7% in this range in the age category 41 to 50 years and again only 8% Mohamed Yasar Arafath, K. Babu Raj. To estimate the serum level of N-terminal pro-brain natriuretic peptide levels in acute coronary syndrome. IAIM, 2019; 6(1): 8-15. Page 9 in the age category 30 to 40 years. The Majority of 30 to 40 years had NT pro-BNP of 100 to 500 (62.5%). In the age category of 41 to 50 years, 50% had NT Pro BNP of 100 to 500 while only 35% was in this range in the age group of 51-60 years. In the age category of 41 to 50 years, 33.3% had NT pro-BNP of < 100 whereas only 10% of 51 to 60 years had NT pro-BNP of < 100 and in the age category of 30 to 40 years, no one had NT pro-BNP of <100. The chi-square test of association was insignificant. Cardiac enzymes (Troponin T and CKMB) was elevated for the majority of the patients (N=27, 67.5%). Cardiac enzymes (Troponin T and CKMB) were normal for only 32.5% of the patients. The correlation of TIMI score with NT pro-BNP was peak positive i.e. if NT pro-BNP is higher, TIMI score was also higher and vice versa but the correlation was insignificant (r=2.54, p = .64). Conclusion: Even though the study is done in patients without clinical signs of heart failure, the levels of NT-proBNP had an inverse relationship with Ejection Fraction. Low NT-proBNP levels at the time of admission rule out high-risk patients or patients with heart failure.

A Case Report of Transfusion-associated Circulatory Overload

Transfusion-associated circulatory overload (TACO) is recently becoming more important than transfusion-related acute lung injury (TRALI) in terms of the number of patients with definite diagnosis as well as its prognosis. In order to diagnose TACO, it is helpful to recognize early the symptoms suspicious of transfusion reaction through electronic medical record system and computer network, and this will be of help for obtaining samples for brain natriuretic peptide (BNP) measurement before and after the onset of transfusion reaction. We report a case in which a transfusion reaction was diagnosed as TACO. A 62-year-old woman was admitted to the emergency room due to bleeding tendency. Two fresh frozen plasma units and one unit of leukocyte-reduced red blood cells were transfused. Blood pressure increased during transfusion, and the chest X-ray showed findings suggestive of newly developed pulmonary edema. N-terminal prohormone of BNP (NT-proBNP) test was carried out using the specimens in refrigerated storage. Compared with the NT-proBNP level measured 12 hours before the transfusion, that measured 6 hours after the transfusion was markedly increased (>48 fold of pre-transfusion level). As a result, this case was diagnosed with TACO.

Clinical significance of plasma NT-proBNP in children with bacterial meningitis / 中国基层医药

Objective@#To investigate the clinical significance of plasma amino-terminal pro-brain natriuretic peptide(NT-proBNP) in children with bacterial meningitis.@*Methods@#From April 2013 to March 2017, 32 children with bacterial meningitis in PICU of the Second People′s Hospital of Liaocheng Affiliated to Taishan Medical College were selected.The patients were evaluated the severity of the disease by Glasgow coma scale(GCS). Thirty-five cases who admitted to the hospital in the same period were selected as the control group, excluding congenital heart disease, chronic cardiac dysfunction, cardiomyopathy, myocarditis, heart failure, chronic renal insufficiency.The blood samples were collected from the hospital in 24h, and the levels of the plasma NT-proBNP, procalcitonin(PCT), C-reactive protein(CRP) and Na ions were determined.@*Results@#Compared with the control group, the levels of the plasma NT-proBNP was significantly increased[(7 123.97±6 901.60)ng/L vs.(39.29±19.41)ng/L, t=5.839, P<0.01], the level of PCT was significantly increased[(25.14±2.35)ng/dL vs.(0.63±0.15ng/dL, t=10.820, P<0.01], the level of CRP was significantly increased[(97.89±4.63mg/dL vs.(5.23±1.22mg/dL, t=21.130, P<0.01], and the GCS was significantly decreased(t=18.132, P<0.01) in children with bacterial meningitis group.The plasma NT-proBNP level of children with GCS<8points[(13 328.08±7 938.85)ng/L]was significantly higher than that in children with GCS 8~14points[(3 401.50±1 526.75)ng/L](t=5.816, P<0.01) and GCS≥15points[(39.74±18.64)ng/L](t=5.816, P<0.01). There was a significant positive correlation between the level of plasma NT-proBNP and PCT(r=0.969, P<0.01), also a significant positive correlation between the level of plasma NT-proBNP and CRP(r=0.961, P<0.01), while a significant negative correlation between the level of plasma NT-proBNP and sodium ions(r=0.886, P<0.01) in children with bacterial meningitis by Pearson correlation test.@*Conclusion@#Detection of the plasma NT-proBNP has significant clinical significance for early diagnosis and assessment of the severity of the illness of children with bacterial meningitis.

Clinical significance of plasma NT－proBNP in children with bacterial meningitis / 中国基层医药

Objective To investigate the clinical significance of plasma amino －terminal pro －brain natriuretic peptide(NT－proBNP) in children with bacterial meningitis.Methods From April 2013 to March 2017, 32 children with bacterial meningitis in PICU of the Second People′s Hospital of Liaocheng Affiliated to Taishan Medical College were selected.The patients were evaluated the severity of the disease by Glasgow coma scale (GCS).Thirty－five cases who admitted to the hospital in the same period were selected as the control group ,excluding congenital heart disease,chronic cardiac dysfunction ,cardiomyopathy,myocarditis,heart failure,chronic renal insufficiency.The blood samples were collected from the hospital in 24h, and the levels of the plasma NT －proBNP, procalcitonin (PCT),C－reactive protein(CRP) and Na ions were determined.Results Compared with the control group ,the levels of the plasma NT－proBNP was significantly increased [(7 123.97 ±6 901.60)ng／L vs.(39.29 ±19.41)ng／L,t＝5.839,P＜0.01],the level of PCT was significantly increased [(25.14 ±2.35) ng／dL vs.(0.63 ±0.15ng／dL,t ＝10.820,P＜0.01],the level of CRP was significantly increased [(97.89 ±4.63mg／dL vs.(5.23 ±1.22mg／dL,t＝21.130,P＜0.01],and the GCS was significantly decreased (t＝18.132,P＜0.01) in children with bacterial meningitis group.The plasma NT －proBNP level of children with GCS ＜8points [( 13 328.08 ±7 938.85 ) ng／L ] was significantly higher than that in children with GCS 8～14points[(3 401.50 ±1 526.75)ng／L](t＝5.816,P＜0.01) and GCS≥15points [(39.74 ±18.64) ng／L] ( t ＝5.816,P＜0.01).There was a significant positive correlation between the level of plasma NT －proBNP and PCT ( r ＝0.969, P ＜0.01), also a significant positive correlation between the level of plasma NT －proBNP and CRP (r＝0.961,P＜0.01),while a significant negative correlation between the level of plasma NT－proBNP and sodium ions(r＝0.886,P＜0.01) in children with bacterial meningitis by Pearson correlation test.Conclusion Detection of the plasma NT－proBNP has significant clinical significance for early diagnosis and assessment of the severity of the illness of children with bacterial meningitis .

Clinical effect of ibuprofen on preventing intracranial hemorrhage in premature infants and its influence on NT-proBNP and ET-1 level / 中国基层医药

Objective To investigate the clinical effect of ibuprofen on preventing intracranial hemorrhage in premature infants and its influence on the levels of NT-proBNP and ET-1.Methods From January 2016 to December 2017,112 premature infants in Taizhou Hospital were selected as study objects after screening by inclusion and exclusion criteria.The infants were randomly divided into observation group and control group according to the digital table,with 56 cases in each group.The control group was treated with routine therapy,and the observation group was given ibuprofen prophylaxis.The incidence of intracranial hemorrhage,clinical index and serum NT-proBNP,ET-1 levels were compared between the two groups.Results There was significant difference in the incidence rate of intracranial hemorrhage between the observation group (17.86％) and the control group (30.36％)(x2 =12.472,P ＜0.05).The serum levels of NT-proBNP and ET-1 in the observation group were significantly lower than those in the control group(all P ＜ 0.05).There were no statistically significant differences in liver function,renal function,coagulation abnormality and oliguria between the two groups (all P ＞ 0.05).There were no statistically significant differences in feeding intolerance and gastric hemorrhage between the two groups (all P ＞ 0.05).Conclusion The application of ibuprofen suspension can effectively prevent intracranial hemorrhage in premature infants,which is worthy of clinical use.

Correlation between NT-proBNP and lipase levels according to the severity of chronic mitral valve disease in dogs

Chronic mitral valve disease (CMVD) is the most common cardiovascular disease in dogs, causing decreased cardiac output that results in poor tissue perfusion and tissue damage to kidneys, pancreas, and other organs. The purpose of this study was to evaluate the relationships between heart disease severity and N-terminal pro B-type natriuretic peptide (NT-proBNP) and lipase in dogs with CMVD, as well as to evaluate longitudinal changes in these values. A total of 84 dogs participated in this 2015 to 2017 study. Serum values of NT-proBNP and lipase were analyzed; radiography was used to measure the vertebral heart score and assess various echocardiographic values. NT-proBNP showed a strong positive correlation with increasing stage of heart disease; lipase showed a mild positive correlation with heart disease stage. When the three values (NT-proBNP, lipase and month) were continuously measured at 6-month intervals, all showed a correlation with the increasing length of the disease.

ST2 elevation in heart failure, predictive of a high early mortality

Background Soluble suppression of tumorigenicity-2 (sST2) is a novel biomarker shown to be useful for prognostic assessment in heart failure (HF). However, very limited data exists about its prognostic utility in patients with HF in India. Methods We studied 150 patients [mean age 67.7 ± 13.3, 93 (62%) males], hospitalized with clinical HF, irrespective of their left ventricular ejection fraction (LVEF). HF was confirmed by N-terminal probrain natriuretic peptide (NT-proBNP) value above 125 ng/L. Primary end point was death or cardiac transplant at 1-year follow-up, with additional telephonic follow-up performed at 2 years. The clinical outcomes were correlated with the sST2 values obtained at the time of initial hospitalization. Results HF was ischemic in origin in 82.0% patients. The primary outcome occurred in 9.3% patients at the end of 1-year follow-up and in 16.7% patients at the end of 2 years. The patients who had events had significantly higher NT-proBNP and sST2 values, but there was no difference in the clinical characteristics, cause of HF, baseline LVEF, or serum creatinine. The patients with elevated sST2 levels (>35 ng/mL) had substantially higher event rates than those with normal sST2 levels (13.7% vs 0.0% at 1-year, P = 0.005; 22.5% vs 4.2% at 2-years, P = 0.004). On multivariate analysis, sST2 was the strongest predictor of adverse outcomes at both 1-year and 2-year follow-ups. Conclusion In patients hospitalized for HF, elevated sST2 >35 ng/mL at the time of initial hospitalization was associated with significantly high mortality over a 2-year period. The prognostic value of sST2 was incremental to that of NT-proBNP. These findings suggest that a single elevated sST2 value at the time of hospitalization should alert the physicians about the high risk of adverse outcomes and should help facilitate timely intensification of HF treatment.

Effectiveness of natriuretic peptide-guided treatmen of chronic heart failure. A meta-analysis / Efectividad del tratamiento guiado por el péptido natriurético para la insuficiencia cardiaca crónica. Meta-análisis

Abstract Objective: To evaluate the efficacy of natriuretic peptide (NP)-guided therapy compared to clinically-guided therapy in reducing mortality and hospital admissions in chronic heart failure (HF) patients. Methods: Randomised clinical trials (RCT) were selected through a systematic review. Four meta-analyses were conducted for the outcomes of overall mortality, HF-related mortality, overall hospital admissions, and HF-related hospital admissions. Heterogeneity between studies and publication bias were also assessed. Results: Nine RCTs were found with a total of 1914 patients. NP-guided therapy significantly reduced overall mortality and HF-related hospital admissions. No significant results were found for HF-related mortality and overall hospital admissions. Some clinical heterogeneity regarding interventions performed was found between studies. Publication bias was found for HF-related and overall hospital admissions. Conclusions: NP-guided therapy seems to improve outcomes compared to clinically-guided therapy. However, heterogeneity found between interventions might reduce the generalisation of these results. Specific interventions of the clinical trials should be examined when making recommendations regarding NP-guided therapy. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/).

Resumen Objetivo: Evaluar la eficacia de la terapia guiada por el péptido natriurético (PN) en comparación con la terapia guiada clínicamente para reducir la mortalidad y la hospitalización de la insuficiencia cardiaca (IC) crónica. Métodos: Los ensayos clínicos aleatorizados fueron seleccionados a través de una revisión sistemática. Cuatro metaanálisis se realizaron para los resultados de mortalidad general, mortalidad por IC, hospitalización general y la hospitalización por IC. Se evaluó la heterogeneidad entre los estudios y el sesgo de publicación. Resultados: Nueve ensayos clínicos aleatorizados se encontraron con un total de 1,914 pacientes. La terapia guiada con el PN reduce significativamente la mortalidad general y la hospitalización por IC. No se encontraron resultados significativos para la mortalidad por IC y la hospitalización general. El sesgo de publicación se encontró para las hospitalizaciones por IC y globales. Conclusiones: La terapia guiada por PN parece mejorar los resultados en comparación con la terapia guiada clínicamente. Sin embargo, la heterogeneidad encontrada entre las intervenciones podría reducir la generalización de estos resultados. Las intervenciones específicas de los ensayos clínicos deben ser analizadas al hacer recomendaciones con respecto a la terapia de guiada por PN. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Evaluation of Cardiopulmonary biomarkers during different stages of Canine Visceral Leishmaniasis / Evaluación de biomarcadores cardiopulmonares durante diferentes etapas de Leishmaniasis visceral canina

ABSTRACT Objective. The purpose of the present study was to test the hypothesis that cardiac alterations participate within different stages of CVL. Materials and methods. Dogs were diagnosed with CVL, were classified as follows; group I (mild disease), group II (moderate disease), group III (severe disease), group IV (very severe disease) and group V included healthy controls. Results. Ig G antibodies against Leishmaniasis in group as tested by IFAT, were deemed 1/64 to 1/16000 among infected groups. Considering the cTnI levels, there were significant differences (p=0.018) between stage IV (group IV) and healthy control group, besides between group IV and group I. Considering D-dimer levels, there was difference between healthy control group and group II, III and IV (p=0.005). Regareing NT-pro BNP levels, there were differences between healthy control group and stage III, IV, besides between stage I with stage III, IV (p=0.000). Conclusions. The results showed that levels of cTnI, Nt pro-BNP and D-dimer were higher in dogs infected with CVL in contrast to healthy dogs, in which levels of those biomarkers were below detection limits. Obtained results suggested the possibility of cTnI and NT pro-BNP as markers for cardiac damage and D-dimer as a supportive tool for a diagnosis of probable thromboembolism in dogs with CVL.

RESUMEN Objetivo. El propósito del presente estudio fue probar la hipótesis de que las alteraciones cardíacas participan en diferentes estadios de CVL. Materiales y métodos. Perros fueron diagnosticados con CVL, se clasificaron de la siguiente manera; Grupo I (enfermedad leve), grupo II (enfermedad moderada), grupo III (enfermedad grave), grupo IV (enfermedad muy grave) y grupo V controles sanos incluidos. Resultados. Los anticuerpos Ig G contra la leishmaniasis en el grupo como probado por IFAT, se consideraron 1/64 a 1/16000 entre los grupos infectados. Considerando los niveles de cTnI, hubo diferencias significativas (p=0.018). Entre el grupo IV y el grupo control sano, además entre el grupo IV y el grupo I. Considerando los niveles D-dímero, hubo diferencia entre el grupo control sano y el grupo II, III y IV (p=0.005). Teniendo en cuenta los niveles de NT-proBNP, hubo diferencia estadística entre el grupo de control sano y el estadio III, IV, además entre la etapa I con estadio III, IV (p=0.000). Conclusiones. Los resultados mostraron que los niveles de cTnI, Nt pro-BNP y D-dímero fueron mayores en perros infectados con CVL en contraste con perros sanos, en los que los niveles de estos biomarcadores estaban por debajo de los límites de detección. Los resultados obtenidos sugirieron la posibilidad de que cTnI y NT pro-BNP como marcadores de daño cardíaco y D-dímero como una herramienta de apoyo para un diagnóstico de tromboembolismo probable en perros con CVL.