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Objective To analyze clinical prognosis, risk factors and predictive indexes of hyperkalemia in recipients after heart transplantation. Methods Clinical data of 158 recipients were retrospectively analyzed. According to the serum potassium levels within postoperative 1-year follow-up, all recipients were divided into the normal serum potassium level group (n=83), hyperkalemia group (n=43) and severe hyperkalemia group (n=32). The incidence and prognosis of hyperkalemia after heart transplantation were summarized. The risk factors and predictive indexes of hyperkalemia after heart transplantation were identified. Results The incidence of hyperkalemia and severe hyperkalemia within postoperative 1 year was 47.5%(75/158) and 20.3%(32/158), respectively. In the severe hyperkalemia group, the fatality was 16%(5/32), higher than 8%(7/83) in the normal serum potassium level group and 7%(3/43) in the hyperkalemia group. The mean serum creatinine (Scr) within 6 months before heart transplantation, the final total bilirubin level before heart transplantation, postoperative hemodialysis time, the Scr level and N-terminal pro-brain natriuretic peptide level at postoperative 1 d were the independent risk factors for hyperkalemia following heart transplantation (all P < 0.05). The mean Scr level within 6 months before heart transplantation, postoperative hemodialysis time, and Scr levels at postoperative 1 and 7 d could be used to predict postoperative severe hyperkalemia. Conclusions The recipients with severe hyperkalemia after heart transplantation obtain poor prognosis. The mean Scr level within 6 months before heart transplantation, the final total bilirubin level before heart transplantation, postoperative hemodialysis time, and the Scr level and N-terminal pro-brain natriuretic peptide level at postoperative 1 d are the independent risk factors for hyperkalemia after heart transplantation. Perioperative Scr level and postoperative hemodialysis time may be used to predict the incidence of severe hyperkalemia within 1 year after heart transplantation.
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Objective:To investigate the diagnostic efficacy of serum N-terminal B-type brain natriuretic peptide (NT-proBNP) and D-dimer for cardiogenic cerebral embolism (CE) based on population in southern Sichuan.Methods:We selected the clinical data of 313 patients with acute cerebral infarction (ACI) for the first time, 34 patients with simple atrial fibrillation (AF) and 30 healthy people who were admitted to the Affiliated Hospital of Southwest Medical University from June 2019 to April 2021. The patients with ACI were divided into four subgroups according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) typing: large artery atherosclerosis (LAA), CE, small artery occlusion (SAO), and indeterminate subtype (UT). The differences in clinical data in the groups were compared. At the same time, the differences of NT-proBNP and D-dimer in serum in CE group, AF group and healthy group were compared; The risk factors of CE were analyzed by binary logistic regression, and the diagnostic efficacy of serum NT-proBNP and D-dimer for CE was evaluated by receiver operating characteristic (ROC) curve.Results:The prevalence of hypertension, diabetes, systolic blood pressure (SBP) and diastolic blood pressure (DBP) at admission, prothrombin time (PT), international normalized ratio (INR), fibrinogen (FIB), D-dimer, fibrinogen degradation products (FDP), National Institutes of Health Stroke Scale (NIHSS) score at admission, NT-proBNP and AF rate were significantly different among ACI subgroups (all P<0.05); There was no significant difference in PT and NIHSS score at admission between LAA group and CE group (all P>0.05). The prevalence of D-dimer, NT-proBNP and AF rate in CE group was significantly higher than those in other three groups (all P<0.05). The D-dimer, NT-proBNP, FDP and SBP level in CE group were significantly higher than those in AF group and healthy group (all P<0.05). Binary logistic regression analysis showed that D-dimer and NT-proBNP were independent risk factors for CE (both P<0.05). When the optimal cut-off value of serum D-dimer was 1.015 mg/L, the area under the ROC curve (AUC) was 0.896 (95% CI: 0.856-0.935, P<0.01); the sensitivity and specificity were 0.878 and 0.833, respectively; the positive predictive value and the negative predictive value were 0.705 and 0.953, respectively. When the best cut-off value of serum NT-proBNP was 657.145 ng/L, the AUC was 0.987 (95% CI: 0.977-0.998, P<0.01); the sensitivity and specificity were 0.959 and 0.963, respectively; the positive predictive value and the negative predictive value were 0.922 and 0.981, respectively. The accuracy of the combined detection of serum D-dimer and NT-proBNP in the diagnosis of CE was higher, and the AUC was 0.988 (95% CI: 0.978-0.998, P<0.01), sensitivity of 0.960, specificity of 0.977, positive predictive value of 0.950, negative predictive value of 0.982. Conclusions:The serum levels of NT-proBNP and D-dimer in CE patients increased significantly; NT-proBNP and D-dimer are important predictors of CE and have higher diagnostic efficacy for CE. The combination of them has a higher specificity for diagnosis.
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Objective:To investigate the efficacy and safety of cedilanid in the treatment of severe pneumonia in infants and the value of preventing heart failure.Methods:A total of 80 children with severe pneumonia admitted to Dezhou Maternal and Child Health Hospital from January 2019 to December 2020 were selected and randomly divided into the control group and the observation group, with 40 cases in each group. The control group received comprehensive treatment, while the observation group was treated with cedilanid (0.01 mg/kg, one-time intravenous injection) on the basis of the control group. The efficacy of both groups was observed after 5 d of treatment. The incidence of heart failure, correction time of heart failure, improvement time of symptoms and signs, and length of hospitalization time were compared between the two groups; the inflammatory markers, myocardial markers and arterial blood gas indexes were compared between the two groups before and after the treatment.Results:The total effective rate in the observation group was higher than that in the control group, and the incidence of heart failure in the observation group was lower than that in the control group: 90.0% (36/40) vs. 72.5% (29/40), 32.5%(13/40) vs. 10.0%(4/40), the differences were statistically significant ( χ2 = 4.02, 4.10, P<0.05). The improvement time of symptoms and signs (restlessness elimination, respiratory improvement, heart rate improvement and disappearance of rhonchus in lung) in the observation group were less than those in the control group ( P<0.05). The levels of procalcitonin (PCT) and N-terminal pro-brain natriuretic peptide (NT-ProBNP), myocardial troponin I(cTnI), and creatine kinase isoenzyme (CK-MB) in the observation group after treatment were lower than those in the control group: (6.15 ± 1.03) μg/L vs. (10.85 ± 2.12) μg/L, (112.02 ± 30.09) ng/L vs. (215.39 ± 55.08) ng/L, (0.68 ± 0.17) μg/L vs. (1.12 ± 0.34) μg/L, (19.05 ± 6.11) U/L vs. (28.97 ± 7.82) U/L, P<0.05. The levels of oxygen partial pressure (PaO 2), blood oxygen saturation (SaO 2) and oxygenation index (PaO 2/FiO 2) in the observation group after treatment were higher than those in the control group: (6.15 ± 1.03) μg/L vs. (10.85 ± 2.12) μg/L, (112.02 ± 30.09) ng/L vs. (215.39 ± 55.08) ng/L, (0.68 ± 0.17) μg/L vs. (1.12 ± 0.34) μg/L, (19.05 ± 6.11) U/L vs. (28.97 ± 7.82) U/L, P<0.05. Conclusions:Early application of small dose of cedilanid in infants with severe pneumonia can effectively reduce the occurrence of heart failure, improve the clinical symptoms and blood gas indicators, with significant curative effect, which is worthy of promotion.
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Objective:To investigate the diagnostic and early-warning value of laboratory test indicators for sepsis-induced myocardial injury (SIMD).Methods:The clinical data of 183 patients with sepsis admitted to the Department of Emergency and Critical Care Medicine of Guangdong Provincial People's Hospital from August 2016 to October 2020 were collected. The patient's age, gender, past medical history, vital signs and pathogen culture results were extracted. Cardiac function, blood routine, liver function, renal function, inflammatory factors, coagulation function, APACHE Ⅱ and SOFA scores were recorded at enrollment and 72 h after admission. SIMD was defined as cTnT ≥300 pg/mL and NT-proBNP ≥1243 pg/mL twice in 72 h intervals between enrolled cases, and the early-warning factors of patients with SIMD were analyzed. The differences in various indicators between the two groups were compared, and Logistic regression analysis was used to explore the diagnostic efficacy of cTnT and NT-proBNP combined for SIMD, and the correlation between PCT/PLT ratio and the occurrence of SIMD.Results:Among 250 patients, 67 patients were excluded for lack of the main indicators, and 183 patients (including 62 patients with history of cardiac disease) were enrolled finally. Among 183 patients with sepsis, 105 patients (57.38%) with cTNT ≥300 pg/mL and NT-proBNP ≥1 243 pg/mL, were diagnosed as myocardial injury; after excluding 62 patients with history of cardiac disease, 59 patients (48.76%) with cTNT ≥300 pg/mL and NT-proBNP ≥1 243 pg/mL were diagnosed as myocardial injury. Logistic regression analysis showed that increased PCT/PLT ratio ( OR=1.585, 95% CI: 1.124-2.237, P=0.009) was an independent risk factor for early-warning of SIMD. The PCT/PLT ratio ( OR= 1.850, 95% CI: 1.103-3.102, P=0.020) could stably predict the occurrence of SIMD in patients without previous history of heart disease. ROC curve analysis showed that PCT/PLT ratio could effectively predict the occurrence of SIMD (AUC=0.693, 95% CI: 0.617-0.769, P<0.001), the optimal cut-off value was 0.177 (sensitivity: 65.7%, specificity: 66.7%). The PCT/PLT ratio was still effective in predicting the occurrence of SIMD after excluding patients with previous history of heart disease (AUC=0.733, 95% CI: 0.643-0.823, P<0.001), and the optimal cut-off value was 0.429 (sensitivity: 55.9%, specificity: 83.9%). Conclusions:The combination of cTnT and NT-proBNP has certain diagnostic value for SIMD, and the PCT/PLT ratio could warn the occurrence of SIMD.
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@#Brain natriuretic peptide (BNP) and amino-terminal pro-brain natriuretic peptide (NT-proBNP) were the main members of the natriuretic peptide family. BNP has the effects of diuretic sodium, reducing sympathetic nervous system activity, dilating blood vessels, and improving the pathological remodeling of heart. Plasma BNP/NT-proBNP levels have been widely used in the diagnosis, severity assessment, prognosis prediction and treatment guidance of heart failure. In recent years, BNP/NT-proBNP has become a research hotspot in the diagnosis and and prognosis judgment of atrial fibrillation, recurrence of atrial fibrillation after radiofrequency ablation and cardioversion and congenital heart disease in infants and children, prediction of postoperative complications, and drug development. This article reviews the latest advances in clinical application and research progress on BNP/NT-proBNP.
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Objective To summarize the experience of diagnosis and treatment of Takotsubo syndrome (TTS) after liver transplantation. Methods Clinical data of one TTS patient after liver transplantation was retrospectively analyzed. Clinical features, diagnosis and treatment strategies were summarized, and literature review was conducted. Results A 43-year-old female patient successfully underwent split liver transplantation due to primary biliary cirrhosis for 8 years. At postoperative 3 d, the patient developed anxiety, irritation, dyspnea, disorientation, hypotension, N-terminal pro-brain natriuretic peptide (NT-proBNP) of > 35 000 pg/mL, creatine kinase isoenzyme (CK-MB) of 5.9 U/L and troponin I (TnI) of 1.78 μg/L. Electrocardiogram indicated the signs of sinus rhythm. Echocardiography indicated diffuse weakening of the left ventricular wall motion and spherical dilatation of the apex, accompanied with moderate and severe regurgitation of the mitral valve and tricuspid valve. The left ventricular ejection fraction (LVEF) declined to 23%, whereas no abnormal segmental motion of ventricular wall or corresponding electrocardiogram changes were observed. The possibility of acute coronary syndrome was excluded. The InterTAK diagnostic score was 73. The diagnosis of TTS after liver transplantation was considered. Metoprolol, coenzyme Q10, recombinant human brain natriuretic peptide, deacetyl lanatoside and lorazepam were given. Echocardiography at postoperative 10 d showed that the left ventricular function was significantly improved and the LVEF recovered to 50%. The patient was discharged 40 d after liver transplantation. The liver function was recovered well. During postoperative follow-up, she was given with metoprolol till the submission date, and no recurrence was reported. Conclusions TTS after liver transplantation is rare in clinical practice. It is difficult to make the diagnosis. The condition of TTS is severe and clinical prognosis is poor. Prompt diagnosis and interventions should be implemented.
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Introduction: Identification of predictors for successful extubation in an Intensive Care Unity and use of Brain Natriuretic Peptides (BNP) in predicting mechanical ventilation weaning and extubation outcome. Aims: Evaluation of the effect of variables such as patient Ìs age, severity score, use of sedation, use of vasoactive drugs, hydric balance, blood gas data, days under mechanical ventilation, the occurrence of adverse events and plasma BNP levels on the success of extubation.Method: A prospective cohort study of adult patients admitted to a 12- bed-general ICU, from April 1st 2016 to August 10th 2017, under mechanical ventilation for > 24 h, accompanied until discharge or death. Clinical variables were analyzed and BNP was assessed before initiation of Spontaneous Breathing Trial (SBT) and then again before extubation. Statistical Analysis: a descriptive and comparative data analysis, univariate and logistic regression analysis for verification of variables independently related to successful extubation (p < 0.05).Results: Study of 105 patients, mean age of 53.9 ± 19.8 years, 81% of success in extubation; the overall mortal-ity rate of 11.4%; variables associated to successful extubation: age, APACHE II, SAPS II, days of hospitalization before ICU admittance, days under mechanical ventilation, days of stay in ICU and occurrence of nosocomial infec-tion (p < 0.05); BNP levels were lower in patients with successful extubation although not statistically significant; multivariate analysis showed that patient's age and days of hospitalization before ICU admittance were each in-dependently linked to extubation failure; APACHE II score and days of hospitalization before ICU admittance were each independently associated to risk of death.Conclusion: Despite being older and with higher severity scores, patients had a higher success rate in extubation than found in similar studies. However, the mortality rate in cases of failed extubation was higher. Data obtained was in agreement to studies that suggested that patient Ìs age, severity score, days of hospitalization before ICU admittance, days of stay in ICU, days under MV and infection occurrence were all variables associated as much extubation failure as to risk of death. A direct association between BNP levels and successful extubation and the usefulness of assessing BNP in the conduction of WMV was not confirmed. (AU)
Introdução: Identificação de fatores preditivos do sucesso da extubação em Unidade de Terapia Intensiva e uso do Peptídeo Natriurético Cerebral (BNP) como preditor do sucesso do desmame da ventilação mecânica e extubação.Objetivo: Avaliação do efeito de variáveis como idade, escores de gravidade, uso de sedação, uso de drogas va-soativas, balanço hídrico, gasometria, dias sob ventilação mecânica, ocorrência de eventos adversos e níveis plas-máticos de BNP no sucesso da extubação .Método: Estudo de coorte prospectivo de pacientes adultos internados em UTI geral com 12 leitos, de 1º de abril de 2016 a 10 de agosto de 2017, sob ventilação mecânica (VM) por > 24 horas, acompanhados até a alta ou óbito. Variáveis clínicas foram analisadas e o BNP dosado antes do início do Teste de Respiração Espontânea (TRE) e, novamente, antes da extubação. Análise estatística: análise descritiva e comparativa dos dados, análise univariada e regressão logística para verificação de variáveis independentemente relacionadas ao sucesso da extubação (p <0,05).Resultados: Avaliados 105 pacientes, idade média 53,9 ± 19,8 anos, sucesso na extubação de 81%; taxa de mortalidade geral de 11,4%; variáveis associadas ao sucesso da extubação: idade, APACHE II, SAPS II, dias de internação antes da admissão na UTI, dias em ventilação mecânica, dias de permanência na UTI e ocorrência de infecção hospitalar (p <0,05); os níveis de BNP foram mais baixos em pacientes com sucesso da extubação, embora não estatisticamente significativos; a análise multivariada mostrou que as variáveis, idade e dias de internação, antes da admissão na UTI, estavam, independentemente, ligadas ao fracasso da extubação; as variáveis APACHE II e dias de internação antes da admissão na UTI estavam, independentemente, associados ao risco de morte.Conclusão: Apesar de mais velhos e com escores de gravidade mais elevados, nossos pacientes apresentaram maior taxa de sucesso na extubação quando comparados a estudos semelhantes. No entanto, a taxa de mortalidade em casos de falha da extubação foi maior. Os dados obtidos estão de acordo com estudos que sugerem que variá-veis como idade, escores de gravidade, dias de internação antes da admissão na UTI, dias de permanência na UTI, dias em VM e ocorrência de infecção estão associadas tanto ao fracasso de extubação quanto ao risco de morte. Não foi possível confirmar a associação direta entre os níveis plasmáticos de BNP e o sucesso da extubação, assim como sua utilidade na condução do desmame da ventilação mecânica. (AU)
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Humans , Respiration, Artificial , Ventilator Weaning , Mortality , Natriuretic Peptide, Brain , Critical Care , Airway Extubation , Simplified Acute Physiology Score , Intensive Care UnitsABSTRACT
Abstract Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia. Sorting nexin 10 (SNX10) has been reported to be an important regulator in embryonic development and human diseases, however, little is known about its role in cardiac disease. The aim of this study was to investigate the clinical significance of SNX10 expression in AF. Methods: Nineteen valvular heart disease patients with AF and nine valvular heart disease patients with sinus rhythm (SR) were enrolled. Atrial tissue samples from patients undergoing open heart surgery were examined. Atrial tissues of normal hearts were obtained from two cases' autopsies. The SNX10 expression and its associations with the degree of fibrosis were analyzed by immunohistochemistry and Masson's trichrome staining. Results: SNX10 expression was detected in the cytoplasm of cardiac cells in human myocardial tissue. The SNX10 expression level was higher in the SR group than in the AF group (P=0.023). SNX10 expression was negatively associated with the degree of fibrosis (P=0.017, Spearman rho=-0.447), the New York Heart Association degree (P=0.003, Spearman rho=-0.545), left atrial diameter (P=0.038, Spearman rho=-0.393), right atrial diameter (P=0.043, Spearman rho=-0.386), and the brain natriuretic peptide (BNP) level 24 hours after surgery (P=0.030, Spearman rho=-0.426), but not the BNP level before surgery and 72 hours after surgery. No statistical significance was observed between SNX10 and the level of troponin T and C-reactive protein. Conclusion: Decreased SNX10 might serve as a potential risk factor in AF of the valvular heart disease.
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Humans , Atrial Fibrillation/etiology , Atrial Appendage , Heart Valve Diseases/surgery , Case-Control Studies , Risk Factors , Sorting Nexins , Heart AtriaABSTRACT
@#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.
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Heart failure is a clinical condition in which a deviation in normal cardiac structure or function is accountable for the incapability of the heart to eject or fill with blood at a proportion proportionate to the requirements of the metabolizing tissues. The detection of heart failure is based on clinical symptoms, signs, chest x rays and reaction to the treatment. BNPs are released by the heart ventricles in reaction to volume load or pressure load physiologically and they function to counteract rennin angiotensin system, cause vasodilatation and natriuresis. The BNP evaluation has gained approval already in the recommendations of European Society of Cardiology for the detection of heart failure. We wanted to study the potential of a new unconventional assay plasma N-Terminal pro BNP in detecting cardiac failure, and correlate the levels of plasma N-Terminal pro BNP with the severity of the cardiac failure and levels of plasma N-Terminal Pro BNP with systolic and diastolic dysfunction. MethodsIt was an analytical cross-sectional study conducted among 50 patients with clinical features of cardiac failure attending medicine OPD and emergency department of the hospital for the duration of 18 months and an equal number of age and sex equivalent fit controls. In subjects with clinical features of heart failure, and in healthy controls, 2 mL of blood sample is drawn for assay of plasma N-Terminal pro BNP within half an hour of presentation. Using biomedical kit plasma N-T pro BNP concentration was measured. The entire period of the assay is 18 min. Detectability range by this method of N-T proBNP is 5 pg/mL to 35,000 pg/mL. ResultsCases comprised of 28 males and 22 females with a mean age 50.80 (13.11) years while controls comprised of 28 males and 22 females with a mean age 50.86 (12.7) years. There was a statistically noteworthy difference in Mean N-T pro BNP between case and control groups, NYHA Class, and age group. Mean N-T pro-BNP is not significantly different at discharge and on 2nd follow-up. For the rest of the diagnoses, there is a notable difference in Mean N-T pro BNP at discharge and on 2nd follow-up. ConclusionsPlasma N-Terminal pro BNP levels are useful from therapeutic point of view (aggressive therapy if needed e.g. Heart transplantation / bilateral pacemaker or invasive therapy may be planned by N-T pro BNP levels).
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Background: The incidence and prevalence rates of heart failure (HF) are increasing worldwide. The prevalence of HF rises exponentially with increasing age and affects 4% to 8% of people older than 65. The leading causes of HF in India include coronary artery disease (CAD), diabetes, hypertension, rheumatic valvular heart diseases and primary cardiac muscle diseases. Rheumatic heart disease (RHD) is still a common cause of HF in India. Epidemiological studies have estimated that 1.5% to 2% population experience HF and it is the main reason for hospital admission of elderly patients. The objective of this study was to establish the etiological factors of heart failureMethods: A cross sectional study of 150 patients above the age of 18 years presented with heart failure diagnosed clinically on the basis of Framingham heart failure criteria and echocardiography, done over a period of one year in department of medicine in BRD medical college Gorakhpur Uttar Pradesh.Results: A total of 150 patients were include in this analysis the majority of patients were male (57.3%). Age of patients ranged from 18 - 70 years and 84% patients were above the age of 40 years.Conclusions: Heart failure was more prevalent in elderly male above 40 years of age. Myocardial infarction, DCMP, rheumatic heart disease and hypertensive heart failure are the common etiology leading to heart failure.
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Objective@#To investigate the clinical significance of serum low-density lipoprotein receptor-related protein 6 (LRP6) level in patients with acute myocardial infarction (AMI).@*Methods@#One hundred and fifty patients with AMI were selected as the AMI group and 150 patients with suspected coronary heart disease without coronary artery stenosis were selected as control group from January 2017 to December 2018 in Quzhou People′s Hospital of Zhejiang. The serum LRP6 levels were determined by Western blot. The serum B-type brain natriuretic peptide (BNP) and cardiac troponin I (cTnI) levels were determined by enzyme-linked immunosorbent assay (ELISA).@*Results@#The levels of total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) in AMI group were higher than those in the control group [(4.42 ± 0.79) mmol/L vs. (3.79 ± 0.82) mmol/L, (1.52 ± 0.33) mmol/L vs. (1.37 ± 0.38) mmol/L, (3.15 ± 0.34) mmol/L vs. (2.91 ± 0.28) mmol/L], and the level of high-density lipoprotein cholesterol (HDL-C) was lower than that in control group [(0.95 ± 0.26) mmol/L vs. (1.21 ± 0.33) mmol/L], and there were significant differences (P<0.05). The level of serum LRP6 and left ventricular ejection fractionin in AMI group were lower than those in control group [0.12 ± 0.03 vs. 0.38 ± 0.07, (53.27 ± 6.89)% vs. (66.82 ± 7.35)%], and the BNP and cTnI levels were higher than those in control group [(78.16 ± 5.27) ng/L vs. (7.13 ± 1.24) ng/L, (125.83 ± 3.26) ng/L vs.(0.71 ± 0.24) ng/L], and there were significant differences (P<0.05). The serum LRP6 level was negatively correlated with LDL-C, BNP, cTnI and SYNTAX scores (r=- 0.587, - 0.523, - 0.542, - 0.583, P<0.05), and was positively correlated with left ventricular ejection fraction (r=0.515, P<0.05).@*Conclusions@#Serum LRP6 level is decreased in patients with AMI. Serum LRP6 is closely related to the severity of AMI and the extent of coronary artery disease.
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Objective@#To investigate the clinical value of plasma brain natriuretic peptide (BNP) levels in predicting the severity of hand, foot and mouth disease (HFMD) in children with coxsackie virus A6 (CV-A6) infection.@*Methods@#A total of 305 children with CV-A6 type HFMD admitted to Xi′an Children′s Hospital from January 2017 to December 2018 were divided into general group (200 cases) and severe group (105 cases) according to the severity of the disease.The receiver operating characteristic curve was used to calculate the value of plasma BNP levels to predict the severe CV-A6 HFMD.Multivariate logistic regression analysis was used to analyze the correlation between the related factors and the severity of CV-A6 HFMD.@*Results@#Compared with the normal group, children in the severe group had statistically significant differences in WBC level, BNP level, neurological symptoms, circulatory disorders, and blood glucose levels(all P<0.05). The optimal cut-off value of the receiver operating characteristic curve for BNP level to predict severe HFMD was 294.85 ng/L.Multivariate logistic regression analysis found that WBC>15×109/L, blood glucose> 8.3 mmol/L, and BNP>294.85 ng/L were related to the severity of CV-A6 HFMD(OR=2.275, P=0.013; OR=6.057, P=0.028; OR=1.008, P<0.001).@*Conclusion@#BNP>294.85 ng/L is closely related to the severity of CV-A6 HFMD and has predictive value.It is an early warning factor for the severity of CV-A6 HFMD.
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Objective To investigate the clinical significance of serum low-density lipoprotein receptor-related protein 6 (LRP6) level in patients with acute myocardial infarction (AMI).Methods One hundred and fifty patients with AMI were selected as the AMI group and 150 patients with suspected coronary heart disease without coronary artery stenosis were selected as control group from January 2017 to December 2018 in Quzhou People's Hospital of Zhejiang.The serum LRP6 levels were determined by Western blot.The serum B-type brain natriuretic peptide (BNP) and cardiac troponin I (cTnI) levels were determined by enzyme-linked immunosorbent assay (ELISA).Results The levels of total cholesterol (TC),triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) in AMI group were higher than those in the control group [(4.42 ± 0.79) mmol/L vs.(3.79 ± 0.82) mmol/L,(1.52 ± 0.33) mmol/L vs.(1.37 ± 0.38) mmol/L,(3.15 ± 0.34) mmol/L vs.(2.91 ± 0.28) rmol/L],and the level of high-density lipoprotein cholesterol (HDL-C) was lower than that in control group [(0.95 ± 0.26) mmol/L vs.(1.21 ± 0.33) mmol/L],and there were significant differences (P ＜ 0.05).The level of serum LRP6 and left ventricular ejection fractionin in AMI group were lower than those in control group [0.12 ± 0.03 vs.0.38 ± 0.07,(53.27 ± 6.89)％ vs.(66.82 ± 7.35)％],and the BNP and cTnI levels were higher than those in control group [(78.16 ± 5.27) ng/L vs.(7.13 ± 1.24) ng/L,(125.83 ± 3.26) ng/L vs.(0.71 ± 0.24) ng/L],and there were significant differences (P ＜ 0.05).The serum LRP6 level was negatively correlated with LDL-C,BNP,cTnI and SYNTAX scores (r =-0.587,-0.523,-0.542,-0.583,P＜ 0.05),and was positively correlated with left ventricular ejection fraction (r=0.515,P ＜ 0.05).Conclusions Serum LRP6 level is decreased in patients with AMI.Serum LRP6 is closely related to the severity of AMI and the extent of coronary artery disease.
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<b>Objective::Evaluate the effects of Danhong injection for perioperative percutaneous coronary intervention (PCI) on cardiac function and thrombolysis in myocardial infarction (TIMI) in patients with acute myocardial infarction (AMI). <b>Method::Computer retrieving CNKI, Wanfang database, VIP database, PubMed, CBM, Web of Science, The Cochrane Library, gathering Danhong injection in percutaneous coronary intervention perioperative application in the treatment of acute myocardial infarction clinic trials. The Cochrane risk evaluation is adopted to improve the quality of literature evaluation, with Revman 5.3 software for Meta-analysis. <b>Result::Participants included in 12 clinic trials contains a total of 1 131 patients, including 569 patients in Danhong treatment and 562 patients in control group. The results showed that compared with conventional treatment, Danhong injection treated patients had LVEF increased obviously [mean difference (MD)=6.62, 95% confidence interval (CI) (4.91, 8.34), <italic>P</italic><0.000 01], the number of TIMI class 3 patients significantly increased[relative risk (RR)=0.22, 95%CI(0.12, 0.41), <italic>P</italic><0.000 01], and BNP levels significantly decreased [MD=151.86, 95%CI (-247.00, -56.72), <italic>P</italic>=0.002]. <b>Conclusion::Danhong injection can improve the function of acute myocardial infarction after percutaneous coronary intervention.
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Objective: To use Escherichia coli ( E. coli) to prepare the recombinant proteins of elastin-like polypeptide (ELP) for displaying the two epitopes of N-terminal pro-brain natriuretic peptide (NT-proBNP)» and to provide the basis for the low-cost and high-efficiency preparation of NT-proBNP detection calibrator. Methods: The epitopes of 13 20 and 63 71 amino acid residues of NT-proBNP were designed and fused with ELP by flexible chain; three kinds of fusion proteins were obtained. The genes encoding the three fusion proteins mentioned above were synthesized by genetic engineering technique and cloned into the pET-28a ( +) vector; the recombinant proteins were induced and expressed automatically in F. coli BL21 (DE3), the recombinant proteins were purified with inverse transition cycling (ITC), and the abilities of their antibodies specificly binding epitopes were detected by Western blotting and ELISA methods. Results: Three kinds of vectors of ELP for displaying NT-proBNP epitopes were successfully constructed, and the corresponding recombinant proteins were expressed in the E. coli. The western blotting and direct ELISA results showed that the specific epitopes displayed by ELP had the better binding ability with the relative antibodies. The results of Sandwich ELISA showed that the protein concentrations of recombinant proteins of ELP for displaying two epitopes of NT-proBNP had a double logarithmic linear dose-dependent relationship with the absorbance (A) value at 450 nm ( r=0.919 1-P<0.01). Conclusion: The ELF is successfully used to display the two epitopes of NT-proBNP. and lay a foundation for the low-cost and high-efficiency preparation of the NT-proBNP detection calibrator.
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OBJECTIVE：To observe the clinical effect and safety of recombinant human brain natriuretic peptide （rhBNP） combined with levosimendan in the treatment of acute decompensated heart failure （ADHF）complicated with renal insufficiency. METHODS：A total of 156 patients with ADHF complicated with renal insufficiency admitted to the Dept. of Cardiology in the Affiliated Hospital of Southwest Medical University during Jan.-Dec. 2019 were randomly divided into rhBNP group ，levosimendan group and combination group ，with 52 patients in each group. All patients received rountine treatment. On this basis ，rhBNP group was given rhBNP for injection [after 1.5 μg/kg intravenous pulse injection，intravenous dripping for 24 h with 0.007 5 μg（/ kg· min）]；leosimendan group was given Leosimendan injection 12.5 mg [intravenous dripping for 1 h with 6-12 μg（/ kg·min），then intravenous dripping for 23 h with 0.1 μg（/ kg·min）]. Combination group received drug combination according to the administration method of single drug group. Three groups received treatment for consecutive 7 d. Cardiac function indexes [heart rate （HR），left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD）]，mean arterial pressure （MAP），pulmonary capillary pressure （PCWP），renal function indexes [estimated glomerular filtration rate （eGFR），serum creatinine （Scr）]，serum levels of cystatin C （Cys-c）and amino-terminal brain natriuretic peptide precursor （NT-proBNP）were observed in 3 groups before and after treatment. Clinical efficacy and the occurrence of ADR were recorded. RESULTS ：Three cases withdrew from the study in rhBNP group and 1 case in levosimendan group ；152 cases completed the study. Before treatment ，there was no statistical significance in cardiac function indexes ，MAP，PCMP，renal function indexes or serum levels of Cys-C and NT-proBNP among 3 groups（P＞0.05）. After treatment ，the HP ，MAP，PCWP and serum level of NT-proBNP in 3 group as well as serum level of Cys-C in combination group were decreased significantly （P＜0.05）；the LVEF in 3 group as well as the eGFR and Scr level in levosimendan group and combination group were significantly increased （P＜0.05），compared with before treatment ；above indexes of combination group were significantly better than those of rhBNP group and levosimendan group （P＜0.05）. Total effective rate of combination group was 94.23％ ，which was significantly higher than those of rhBNP group （77.55％）and levosimendan group （76.47％）（P＜0.05）. There was no significant difference in the incidence of ADR among 3 groups（P＞ 0.05）. CONCLUSIONS ：rhBNP combined with levosimendan in the treatment of ADHF complicated with renal insufficiency can significantly increase the clinical efficacy ，and improve cardiac and renal function but don ’t increase the incidence of ADR.
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ObjectiveThe assessment of volume load status in patients with acute heart failure is of great significance for preventing volume overload. The aim of this study was to explore the predictive value of NT-proBNP level and IVC-CI on volume load and prognosis in patients with acute heart failure. MethodsFrom January 2017 to April 2019, the clinical characteristics of 98 patients with acute heart failure diagnosed and treated in the Peking University People's Hospital were retrospectively reviewed in this study. All of them were treated with routine anti-heart failure treatment. According to the level of relative volume balance, they were divided into volume overload group (65 cases) and non-volume overload group (33 cases). All the patients were followed up for 30 days after discharge. The patients with death and cardiogenic rehospitalization were included in the event group (30 cases), and the rest were in the non-event group (68 cases). NT-proBNP and IVC-CI in different volume load groups and different prognosis groups were compared. The volume index levels (serum albumin, hemoglobin, hematocrit, PCWP, CVP) of patients in different volume load groups were compared. The effects of NT-proBNP and IVC-CI on volume load and prognosis of patients were analyzed.ResultsThe levels of NT-proBNP [（1306.39±313.98）pg/mL], PCWP [（19.63±1.95）mmHg] and CVP [（14.65±1.03）cmHg] in the volume overload group were higher than those in the non-volume overload group, while the IVC-CI [（38.26±8.14）%], albumin [（16.23±2.12）g/L], hemoglobin and hematocrit [（36.26±2.78）%] in the volume overload group were lower than those in the non-volume overload group (P0.05). On discharge, the AUC of NT-proBNP, IVC-CI in predicting patients with acute heart failure was respectively 0.806 and 0.847. Although the prediction accuracy was relatively high, the AUC of combined prediction was 0.982, which was significantly higher than that of NT-proBNP and IVC-CI (Z=3.589, 3.274, both P<0.05).Conclusion There is a correlation between NT-proBNP, IVC-CI and volume indexes. The combined detection of NT-proBNP and IVC-CI can help to assess the volume load status of patients with acute heart failure and improve the predictive value of short-term prognosis of patients.
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@#Objective To explore the predictive value of N-terminal-pro-brain natriuretic peptide (NT-ProBNP) for postoperative early outcomes in infants with aortic coarctation (CoA). Methods A retrospective study was conducted in 344 children with CoA admitted to our hospital from September 2014 to October 2017, including 206 males (59.9%) and 138 females (40.1%), with an average age of 0.2-60.0 (7.1±10.6) months. The levels of NT-proBNP, clinical characteristics, imaging data and early follow-up results were collected and analyzed. Results Compared with the normal NT-proBNP group, there were statistical differences in age, the proportion of RACHS-1≥3, the proportion of preoperative pneumonia and dysplastic aortic arch, preoperative cardiac function, left ventricular wall thickness, left ventricular dilatation, hospital stay, ICU duration, ventilator duration, duration of vasoactive drugs use, delayed chest closure, nasal continuous positive airway pressure (nCPAP), postoperative cardiac insufficiency in the abnormal NT-proBNP group (P<0.05). According to multivariate logistic regression analysis, NT-proBNP level (>3 000 pg/mL) was an independent risk factor for prolonged ICU duration [OR=3.17, 95%CI (1.61, 6.23)], prolonged ventilator duration [OR=5.84, 95%CI (2.86, 11.95)], prolonged use of vasoactive drugs [OR=2.22, 95%CI (1.22, 4.02)], postoperative cardiac insufficiency [OR=3.10, 95%CI (1.64, 5.85)]; NT-proBNP level (> 5 000 pg/mL) was an independent risk factor for delayed chest closure [OR=3.55, 95%CI (1.48, 8.50)]. Conclusion NT-proBNP level in children with CoA can be affected by many factors, including age, complexity of congenital heart disease, preoperative cardiac insufficiency, et al. The level of NT-proBNP has predictive value for postoperative early outcomes.
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Resumen Introducción: La utilidad clínica del péptido natriurético cerebral (NT-proBNP) como marcador pronóstico en pacientes pediátricos con falla cardíaca es controversial. El puntaje inotrópico vasoactivo 24 horas después de la operación cardíaca en pacientes pediátricos es un importante predictor de morbilidad y mortalidad posoperatoria. Objetivo: Determinar si existe correlación entre los valores séricos de NT-proBNP y el puntaje inotrópico vasoactivo a las 24 horas posteriores a la intervención cardíaca en pacientes pediátricos atendidos en una unidad de terapia intensiva. Material y métodos: Estudio transversal analítico. Se realizó un análisis de correlación de Spearman (rs) entre la cifra sérica de NT-proBNP y el puntaje inotrópico máximo tomados ambos a las 24 horas del postoperatorio. Se consideró estadísticamente significativo un valor de p menor que 0.05. Resultados: Se incluyó a 40 pacientes, 52.5% del sexo masculino, 72.5% era mayor de un año de edad al momento de la operación. Se encontró una baja correlación (rs = 0.26) entre las concentraciones séricos de NT-proBNP y el puntaje inotrópico vasoactivo máximo a las 24 horas; dicha correlación no fue estadísticamente significativa (p = 0.09). Conclusiones: Este estudio es el primero en investigar la correlación entre estos marcadores y los resultados podrían sentar un antecedente que marque el inicio de múltiples investigaciones, con la finalidad de establecer nuevas herramientas diagnósticas, pronósticas y terapéuticas.
Abstract Introduction: The clinical utility of brain natriuretic peptide (NT-proBNP) as a prognostic marker in pediatric patients with heart failure is controversial. The maximum vasoactive inotropic score at 24 h after cardiac surgery in pediatric patients is an important predictor of morbidity and postoperative mortality. Objective: To determine if there is a correlation between the serum levels of NT-proBNP and the maximum vasoactive inotropic score at 24 hours after cardiac surgery in pediatric patients seen in the Intensive Care Unit. Material and methods: An analytical cross-sectional study. A Spearman correlation analysis (rs) was performed between the serum level of NT-proBNP and the maximum inotropic score both taken at 24 hours postoperatively. A value of p less 0.05 was considered statistically significant. Results: 40 patients were included, 52.5% to the male sex, 72.5% were older than 1 year of age at the time of surgery. A low correlation (rs = 0.26) was found between the serum levels of NT-proBNP and the maximum vasoactive inotropic score at 24 hours, this correlation was not statistically significant (p = 0.09). Conclusions: To our understanding, the present study is the first to investigate whether there is a correlation between these markers, so our results could set an important precedent that marks the beginning of multiple investigations in our critically ill patients in order to establish new diagnostic, prognostic and therapeutic approaches.