Predictive value of plasma TMAO combined with NT-proBNP on the prognosis and length of hospitalization of patients with ischemic heart failure / 中华心血管病杂志

Objective: To explore the value of the assessment of plasma trimethylamine N-oxide (TMAO) combined with N-terminal pro-B-type natriuretic peptide (NT-proBNP) on predicting the all-cause mortality, length of hospitalization, and hospital cost in ischemic heart failure (IHF) patients. Methods: This prospective cohort study included 189 patients (157 males, mean age (64.0±10.5) years) with a left ventricular ejection fraction<45% caused by coronary artery disease, who hospitalized in our department from March 2016 to December 2020. Baseline data, including demographics, comorbid conditions and laboratory examination, were analyzed. The cumulative rate of all-cause mortality was evaluated using the Kaplan-Meier method and compared between the groups according to the log-rank test. Relative risks were reported as hazard ratios (HR) and 95% confidence interval (95%CI) calculated using the Cox proportional-hazards analysis, with stepwise adjustment for covariables. Spearman correlation analysis was then performed to determine the relationship between TMAO combined with NT-proBNP and length of hospitalization and hospital cost. Results: There were 50 patients in the low TMAO+low NT-proBNP group, 89 patients in high TMAO or high NT-proBNP group, 50 patients in high TMAO+high NT-proBNP group. The mean follow-up period was 3.0 years. Death occurred in 70 patients (37.0%), 27 patients (54.0%) in high TMAO+high NT-proBNP group, 29 patients (32.6%) in high TMAO or high NT-proBNP group and 14 patients (28.0%) in low TMAO+low NT-proBNP group. TMAO, in combination with NT-proBNP, improved all-cause mortality prediction in IHF patients when stratified as none, one or both biomarker(s) elevation, with the highest risk of all-cause mortality in high TMAO+high NT-proBNP group (HR=3.62, 95%CI 1.89-6.96, P<0.001). ROC curve analysis further confirmed that TMAO combined with NT-proBNP strengthened the prediction performance on the risk of all-cause death (AUC=0.727(95%CI 0.640-0.813), sensitivity 55.0%, characteristic 83.1%). Spearman correlation analysis showed that IHF patients with high TMAO and high NT-proBNP were positively associated with longer duration of hospitalization (r=0.191,P=0.009), but not associated with higher hospital cost (r=0.030, P=0.686). Conclusions: TMAO combined with NT-proBNP are valuable prediction tool on risk stratification of patients with IHF, and those with two biomarkers elevation face the highest risk of mortality during follow-up period, and are associated with the longer hospital stay.

Péptido natriurético cerebral tipo B como marcador de sobrecarga hemodinámica del conducto arterioso permeable en el recién nacido prematuro / B-type brain natriuretic peptide as marker of hemodynamic overload of the patent ductus arteriosus in the preterm infant

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.

Valor Prognóstico da Troponina T e do Peptídeo Natriurético Tipo B em Pacientes Internados por COVID-19 / Prognostic Value of Troponin-T and B-Type Natriuretic Peptide in Patients Hospitalized for COVID-19

Resumo Fundamento: A COVID-19 causa grave acometimento pulmonar, porém o sistema cardiovascular também pode ser afetado por miocardite, insuficiência cardíaca e choque. A elevação de biomarcadores cardíacos tem sido associada a um pior prognóstico. Objetivos: Avaliar o valor prognóstico da Troponina T (TnT) e do peptídeo natriurético tipo B (BNP) em pacientes internados por Covid-19. Métodos: Amostra de conveniência de pacientes hospitalizados por COVID-19. Foram coletados dados dos prontuários com o objetivo de avaliar a relação da TnT e o BNP medidos nas primeiras 24h de admissão com o desfecho combinado (DC) óbito ou necessidade de ventilação mecânica. Análise univariada comparou os grupos com e sem DC. Modelo multivariado de Cox foi utilizada para determinar preditores independentes do DC. Resultados: Avaliamos 183 pacientes (idade=66,8±17 anos, sendo 65,6% do sexo masculino). Tempo de acompanhamento foi de 7 dias (1 a 39 dias). O DC ocorreu em 24% dos pacientes. As medianas de TnT e BNP foram 0,011 e 0,041 ng/dl (p<0,001); 64 e 198 pg/dl (p<0,001) respectivamente para os grupos sem e com DC. Na análise univariada, além de TnT e BNP, idade, presença de doença coronariana, saturação de oxigênio, linfócitos, dímero-D, proteína C reativa titulada (PCR-t) e creatinina, foram diferentes entre os grupos com e sem desfechos. Na análise multivariada boostraped apenas TnT (1,12[IC95%1,03-1,47]) e PCR-t (1,04[IC95%1,00-1,10]) foram preditores independentes do DC. Conclusão: Nas primeiras 24h de admissão, TnT, mas não o BNP, foi marcador independente de mortalidade ou necessidade de ventilação mecânica invasiva. Este dado reforça ainda mais a importância clínica do acometimento cardíaco da COVID-19. (AArq Bras Cardiol. 2020; 115(4):660-666)

Abstract Background: COVID-19 causes severe pulmonary involvement, but the cardiovascular system can also be affected by myocarditis, heart failure and shock. The increase in cardiac biomarkers has been associated with a worse prognosis. Objectives: To evaluate the prognostic value of Troponin-T (TNT) and natriuretic peptide (BNP) in patients hospitalized for Covid-19. Methods: This was a convenience sample of patients hospitalized for COVID-19. Data were collected from medical records to assess the association of TnT and BNP measured in the first 24 hours of hospital admission with the combined outcome (CO) of death or need for mechanical ventilation. Univariate analysis was used to compare the groups with and without the CO. Cox's multivariate model was used to determine independent predictors of the CO. Results: We evaluated 183 patients (age = 66.8±17 years, 65.6% of which were males). The time of follow-up was 7 days (range 1 to 39 days). The CO occurred in 24% of the patients. The median troponin-T and BNP levels were 0.011 and 0.041ng/dL (p <0.001); 64 and 198 pg/dL (p <0.001), respectively, for the groups without and with the CO. In the univariate analysis, in addition to TnT and BNP, age, presence of coronary disease, oxygen saturation, lymphocytes, D-dimer, t-CRP and creatinine, were different between groups with and without outcomes. In the bootstrap multivariate analysis, only TnT (1.12 [95% CI 1.03-1.47]) and t-CRP (1.04 [95% CI 1.00-1.10]) were independent predictors of the CO. Conclusion: In the first 24h of admission, TnT, but not BNP, was an independent marker of mortality or need for invasive mechanical ventilation. This finding further reinforces the clinical importance of cardiac involvement in COVID-19. (Arq Bras Cardiol. 2020; 115(4):660-666)

Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19 / 中华心血管病杂志

Objective: To evaluate the cardiovascular damage of patients with COVID-19, and determine the correlation of serum N-terminal pro B-type natriuretic peptide (NT-proBNP） and cardiac troponin-I (cTnI） with the severity of COVID-19, and the impact of concomitant cardiovascular disease on severity of COVID-19 was also evaluated. Methods: A cross-sectional study was designed on 150 consecutive patients with COVID-19 in the fever clinic of Tongji Hospital in Wuhan from January 19 to February 13 in 2020, including 126 mild cases and 24 cases in critical care. Both univariate and multivariate logistic regression were used to analyze the correlation of past medical history including hypertension, diabetes and coronary heart disease (CHD）, as well as the levels of serum NT-proBNP and cTnI to the disease severity of COVID-19 patients. Results: Age, hypersensitive C-reactive protein(hs-CRP) and serum creatinine levels of the patients were higher in critical care cases than in mild cases(all P<0.05). Prevalence of male, elevated NT-proBNP and cTnI, hypertension and coronary heart disease were significantly higher in critical cases care patients than in the mild cases(all P<0.05). Univariate logistic regression analysis showed that age, male, elevated NT-proBNP, elevated cTnI, elevated hs-CRP, elevated serum creatinine, hypertension, and CHD were significantly correlated with critical disease status(all P<0.05). Multivariate logistic regression analysis showed that elevated cTnI(OR=26.909，95%CI 4.086-177.226，P=0.001) and CHD (OR=16.609，95%CI 2.288-120.577，P=0.005) were the independent risk factors of critical disease status. Conclusions: COVID-19 can significantly affect the heart function and lead to myocardial injury. The past medical history of CHD and increased level of cTnI are 2 independent determinants of clinical disease status in patients with COVID-19.

B-type natriuretic peptide levels and diagnostic accuracy: excess fluid volume / Niveles del péptido natriurético tipo B y precisión diagnóstica: volumen de líquidos excesivo / Níveis do peptídeo natriurético tipo B e acurácia diagnóstica: volume de líquidos excessivo

ABSTRACT Aim: To analyze the behavior of B-type natriuretic peptide (BNP) in the presence of defining characteristics (DCs) of the nursing diagnosis Excess fluid volume (00026) in patients hospitalized for acute decompensated heart failure. Methods: Cohort study of patients admitted with acute decompensated heart failure (September 2015 to September 2016) defined by Boston Criteria. Patients hospitalized for up to 36 h with BNP values ≥ 100 pg/ml were included; BNP values at baseline-final assessment were compared by Wilcoxon test, the number of DCs at baseline-final assessment was compared by paired t-test. Results: Sixty-four patients were included; there was a significant positive correlation between delta of BNP and the number of DCs present at initial clinical assessment. Conclusions: The behavior of BNP was correlated to the DCs indicating congestion. With clinical compensation, DCs and BNP decreased. The use of this biomarker may provide additional precision to the nursing assessment.

RESUMEN Objetivo: Analizar el comportamiento del péptido natriurético tipo B (BNP) en presencia de características definitorias (CD) del diagnóstico de enfermería Exceso de volumen de líquidos (00026) en pacientes hospitalizados por insuficiencia cardíaca aguda descompensada (ICAD). Métodos: Estudio de cohorte de pacientes ingresados ​​con ICAD (septiembre/2015 a septiembre/2016).Se incluyeron pacientes hospitalizados hasta 36 h con valores de BNP ≥ 100 pg / ml; Los valores de BNP en la evaluación inicial basal se compararon mediante la prueba de Wilcoxon, el número de CD en la evaluación inicial basal se comparó mediante el Test-T apareado. Resultados: Se incluyeron 64 pacientes; hubo una correlación positiva significativa entre el delta del BNP y las CD presentes en la evaluación clínica inicial. Conclusiones: El comportamiento del BNP se correlacionó con las CD que indican congestión. Con compensación clínica, las CD y el BNP disminuyeron. El uso del BNP puede proporcionar precisión adicional a la evaluación de enfermería.

RESUMO Objetivo: Analisar o comportamento do peptídeo natriurético tipo B (BNP) na presença de características definidoras (CDs) do diagnóstico de enfermagem Excesso de volume de líquidos (00026) em pacientes hospitalizados por insuficiência cardíaca descompensada. Métodos: Estudo de coorte com pacientes internados com insuficiência cardíaca descompensada (setembro-2015 a setembro-2016), definida pelos Critérios de Boston. Pacientes hospitalizados por mais de 36 horas, valor de BNP ≥ 100 pg/ml foram incluídos; valores de BNP basal-final foram comparados pelo teste Wilcoxon; as CDs no basal-final foram comparadas pelo teste t pareado. Resultados: Sessenta e quatro pacientes foram incluídos; houve correlação positiva significativa entre o delta de BNP com o número de CDs presentes na avaliação clínica inicial. Conclusões: O comportamento do BNP foi correlacionado com as CDs, indicando congestão. Com a compensação clínica, as CDs e a concentração de BNP diminuíram. O uso deste biomarcador pode fornecer precisão adicional à avaliação de enfermagem.

Correlación entre los valores séricos de NT-proBNP y el puntaje inotrópico vasoactivo máximo en las primeras 24 horas después de una intervención de cirugía cardíaca / Correlation between NT-proBNP levels and the maximun vasoactive-inotropic score in the first 24 hours post-intervention of cardiac surgery

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.

The Usefulness of Admission Plasma NT-pro BNP Level to Predict Left Ventricular Aneurysm Formation after Acute ST-Segment Elevation Myocardial Infarction / Utilidade do Nível de NT-Pro-BNP no Plasma à Internação em Predizer a Formação de Aneurisma do Ventrículo Esquerdo após Infarto Agudo do Miocárdio com Elevação do Segmento ST

Abstract Background: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI). Methods: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. Results: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. Conclusions: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.

Resumo Fundamento: O aneurisma do ventrículo esquerdo (AVE) é uma importante complicação do infarto agudo do miocárdio (IAM). Objetivo: Investigar o papel da porção N-terminal do pró-hormônio do peptídeo natriurético do tipo B (NT-proBNP) para predizer o desenvolvimento de AVE após infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST). Métodos: Incluímos prospectivamente 1519 pacientes consecutivos com IAMCST. Os pacientes foram divididos em dois grupos de acordo com o desenvolvimento de AVE nos seis meses após o infarto do miocárdio. Os pacientes com ou sem AVE foram examinados para determinar se existia uma relação significativa entre os valores basais do NT-proBNP e as características clínicas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: O AVE foi detectado em 157 pacientes (10,3%). O nível basal do NT-proBNP foi significativamente maior em pacientes que desenvolveram AVE após IAM (523,5 ± 231,1 pg/mL vs. 192,3 ± 176,6 pg/mL, respectivamente, p < 0,001). Os preditores independentes da formação de AVE após IAM foram idade > 65 anos, tabagismo, classe Killip > 2, cirurgia de revascularização miocárdica anterior, insuficiência cardíaca pós-infarto do miocárdio, fração de ejeção do ventrículo esquerdo < 50%, falha de reperfusão, fenômeno de no-reflow, pico de troponina I e CK-MB e NT-proBNP > 400 pg/mL na internação. Conclusões: Nossos achados indicam que o nível plasmático do fragmento N-terminal do peptídeo natriurético tipo B na admissão, entre outras variáveis, fornece informações preditivas valiosas sobre o desenvolvimento de AVE após o IAMCST agudo.

Mean platelet volume as a prognostic factor for venous thromboembolic disease / Volumen plaquetario medio como factor pronóstico de la enfermedad tromboembólica venosa

ABSTRACT Background: Mean platelet volume (MPV) is a risk factor for cardiovascular and inflammatory diseases. Aim: To evaluate the association between high MPV and 90-day mortality after an episode of venous thromboembolism (VTE). Material and Methods: Retrospective cohort of 594 patients with a median age of 73 years (58% women) with a first episode VTE, included in an institutional Thromboembolic Disease registry between 2014 and 2015. MPV values were obtained from the automated blood cell count measured at the moment of VTE diagnosis. Volumes ≥ 11 fL were classified as high. All patients were followed for 90 days to assess survival. Results: The main comorbidities were cancer in 221 patients (37%), sepsis in 172 (29%) and coronary artery disease in 107 (18%). Median MPV was 8 fl (8-9), brain natriuretic peptide 2,000 pg/ml (1,025-3,900) and troponin 40 pg/ml (19.5-75). Overall mortality was 20% (121/594) during the 90 days of follow-up. Thirty three deaths occurred within 7 days and 43 within the first month. The loss of patients from follow-up was 5% (28/594) at 90 days. Mortality among patients with high MP was 36% (23/63). The crude mortality hazard ratio (HR) for high MPV was 2.2 (95% confidence intervals (CI) 1.4-3.5). When adjusted for sepsis, oncological disease, heart disease, kidney failure and surgery, the mortality HR of high MPV was 2.4 (CI95% 1.5-3.9) in the VTE group, 2.3 (CI95% 1.5-4.4) in the deep venous thrombosis group, and 2.9 (CI95% 1.6 −5.6) in the pulmonary embolism group. Conclusions: High MPV is an independent risk factor for mortality following an episode of VTE.

Antecedentes: El volumen plaquetario medio (VPM) es un factor de riesgo de complicaciones cardiovasculares y enfermedades inflamatorias. Objetivo: Evaluar la asociación entre VPM alto y la mortalidad a los 90 días después de un episodio de tromboembolismo venoso (ETV). Material y Métodos: Cohorte retrospectiva de 594 pacientes adultos con una edad media de 73 años (58% mujeres) con un primer episodio de ETV incluidos en un registro de enfermedad tromboembólica institucional entre 2014 y 2015. Se obtuvieron valores de VPM desde el hemograma tomado en el momento del diagnóstico de ETV y un volumen ≥ 11 fL fue clasificado como alto. Todos los pacientes fueron seguidos durante 90 días para determinar sobrevida. Resultados: Las comorbilidades fueron cáncer en 221 pacientes (37%), sepsis en 172 (29%) y enfermedad coronaria en 107 (18%). La mediana de VPM fue 8 fl (89), el péptido natriurético cerebral fue de 2.000 pg/ml (1.025-3.900) y la troponina fue de 40 pg/ml (19,5-75). La mortalidad global a 90 días fue 20% (121/594). Treinta y tres muertes ocurrieron dentro de los 7 días y 43 en el primer mes. La pérdida de seguimiento de pacientes fue de 5% (28/594) a los 90 días. La mortalidad en el grupo con VPM alto fue 36% (23/63). La razón de riesgo (HR) cruda de la mortalidad para un VPM alto fue de 2,2 (intervalos de confianza (IC) de 95% 1,4-3,5). Cuando se ajustó por sepsis, enfermedad oncológica, enfermedad cardíaca, insuficiencia renal y cirugía, la HR de muerte para un VPM alto fue de 2,4 (IC95% 1,5-3,9) en el grupo de ETV; 2,3 (IC95% 1,5-4,4) en el grupo de trombosis venosa profunda; y 2,9 (CI95% 1,6 −5,6) en el grupo de embolia pulmonar. Conclusiones: Un VPM alto es un factor de riesgo independiente de mortalidad después de un episodio de ETV.

Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia? / Os níveis de pró-peptídeo natriurético cerebral N-terminal determinam o prognóstico de pneumonia adquirida na comunidade?

ABSTRACT Objective: Pneumonia is a leading cause of mortality worldwide, especially in the elderly. The use of clinical risk scores to determine prognosis is complex and therefore leads to errors in clinical practice. Pneumonia can cause increases in the levels of cardiac biomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP). The prognostic role of the NT-proBNP level in community acquired pneumonia (CAP) remains unclear. The aim of this study was to evaluate the prognostic role of the NT-proBNP level in patients with CAP, as well as its correlation with clinical risk scores. Methods: Consecutive inpatients with CAP were enrolled in the study. At hospital admission, venous blood samples were collected for the evaluation of NT-proBNP levels. The Pneumonia Severity Index (PSI) and the Confusion, Urea, Respiratory rate, Blood pressure, and age ≥ 65 years (CURB-65) score were calculated. The primary outcome of interest was all-cause mortality within the first 30 days after hospital admission, and a secondary outcome was ICU admission. Results: The NT-proBNP level was one of the best predictors of 30-day mortality, with an area under the curve (AUC) of 0.735 (95% CI: 0.642-0.828; p < 0.001), as was the PSI, which had an AUC of 0.739 (95% CI: 0.634-0.843; p < 0.001), whereas the CURB-65 had an AUC of only 0.659 (95% CI: 0.556-0.763; p = 0.006). The NT-proBNP cut-off level found to be the best predictor of ICU admission and 30-day mortality was 1,434.5 pg/mL. Conclusions: The NT-proBNP level appears to be a good predictor of ICU admission and 30-day mortality among inpatients with CAP, with a predictive value for mortality comparable to that of the PSI and better than that of the CURB-65 score.

RESUMO Objetivo: A pneumonia é uma das principais causas de mortalidade no mundo, especialmente em idosos. O uso de escores de risco clínico para determinar o prognóstico é complexo e, portanto, leva a erros na prática clínica. A pneumonia pode causar aumento nos níveis de biomarcadores cardíacos, como o N-terminal pro-brain natriuretic peptide (NT-proBNP, pró-peptídeo natriurético cerebral N-terminal). O papel prognóstico do nível de NT-proBNP na pneumonia adquirida na comunidade (PAC) continua incerto. O objetivo deste estudo foi avaliar o papel prognóstico do nível de NT-proBNP em pacientes com PAC, bem como sua correlação com escores de risco clínico. Métodos: Pacientes consecutivos internados com PAC foram incluídos no estudo. Na internação hospitalar, foram coletadas amostras de sangue venoso para avaliação dos níveis de NT-proBNP. Foram calculados o Pneumonia Severity Index (PSI, Índice de Gravidade de Pneumonia) e o escore Confusão mental, Ureia, frequência Respiratória, Blood pressure (pressão arterial) e idade ≥ 65 anos (CURB-65). O desfecho primário de interesse foi mortalidade por todas as causas nos primeiros 30 dias após a admissão hospitalar, e um desfecho secundário foi admissão na UTI. Resultados: O nível de NT-proBNP foi um dos melhores preditores de mortalidade em 30 dias, com uma área sob a curva (ASC) de 0,735 (IC95%: 0,642-0,828; p < 0,001), assim como o PSI, que teve uma ASC de 0,739 (IC95%: 0,634-0,843; p < 0,001), enquanto CURB-65 teve uma ASC de apenas 0,659 (IC95%: 0,556-0,763; p = 0,006). O nível de corte do NT-proBNP que mostrou ser o melhor preditor de admissão na UTI e de mortalidade em 30 dias foi de 1.434,5 pg/ml. Conclusões: O nível de NT-proBNP parece ser um bom preditor de admissão na UTI e de mortalidade em 30 dias entre pacientes internados com PAC, com um valor preditivo para mortalidade comparável ao do PSI e superior ao do CURB-65.

NT- Péptido natriurético cerebral en la evaluación de respuesta al tratamiento de la insuficiencia cardíaca con levosimendan en pacientes pediátricos / NT-brain natriuretic peptide in the assessment of response to levosimendan treatment in pediatric patients with heart failure

Introducción: El tratamiento de la insuficiencia cardiaca ha incorporado drogas inotrópicas de muy alto costo, como el levosimendan (LEVO). La evaluación de la respuesta a estas drogas en pediatría ofrece dificultades por lo que la medición de biomarcadores como la prohormona N-Terminal Péptido Natriurético Cerebral (NT-ProBNP) podrían ser de utilidad. Objetivo: describir la variación del NT-ProBNP y su correlación con parámetros ecocardiográficos en respuesta a la administración de levosimendan en pacientes pediátricos con insuficiencia cardiaca. Diseño: estudio descriptivo, observacional y prospectivo, sin intervención. Pacientes y métodos: se incluyeron pacientes con insuficiencia cardiaca de 0 a 18 años internados en terapia intensiva a los cuales se les pudo realizar dosaje de NT ProBNP pre LEVO. Se midió dicho péptido al 1°, 3° y 5° día post LEVO. Con cada determinación se realizó ecocardiograma doppler. Resultados: Se enrolaron 15 pacientes, mediana de edad 188,5 días (IQR 25-75: 56-475); de peso 5,475 kg (IQR 25-75: 2.8-7.5). El 80% fueron pacientes con reparación quirúrgica de cardiopatías congénitas, 13.3% con ventrículo único. La mediana de valor de NT ProBNPantes de la administración de LEVO fue 8924.5 pg./ml (IQR 25-75: 4096-20419,75). El 80% de la población presentó descenso en el valor de pro BNP post LEVO y en 10 (66.6%) el descenso fue mayor o igual al 30%. La evaluación global de la función miocárdica no presentó diferencias antes y después del LEVO. Conclusiones: El 66% de los pacientes presentó una disminución de al menos un 30% en los valores de NT ProBNP luego de la administración de levosimendan

Introduction: Very high-cost inotropic drugs, such as levosimendan (LEVO), have been incorporated in the treatment of heart failure. Evaluation of the response to these drugs in children is difficult and measurement of biomarkers such as the prohormone N-terminal pro b-type natriuretic peptide (NT-proBNP) may be of use. Objective: To describe variation of NT-ProBNP and its correlation with echocardiographic parameters in response to the administration of LEVO in pediatric patients with heart failure. Design: A prospective, descriptive, observational, non-interventional study. Patients and methods: Patients between 0 and 18 years of age with heart failure admitted to the intensive care unit in whom pre-LEVO NT-ProBNP levels could be measured were included. NT-ProBNP levels were measured at day 1, 3, and 5 post LEVO. At each measurement, a Doppler echocardiogram was performed. Results: 15 patients with a median age of 188.5 days (IQR 25-75: 56-475) and a weight of 5.475 kg (IQR 25-75: 2.8-7.5) were enrolled. Of the patients, 80% had undergone surgery for congenital heart defects, 13.3% with a single ventricle. Median NT-ProBNP levels before LEVO administration were 8924.5 pg./ml (IQR 25-75: 4096-20419.75). Overall, 80% of the patients had a decrease of post-LEVO NT-ProBNP levels and in 10 (66.6%) the decrease was greater than or equal to 30%. Overall evaluation of myocardial function did not show differences before and after LEVO administration. Conclusions: 66% of the patients presented with a decrease of at least 30% of NT-ProBNP levels after LEVO administration

Biomarkers of cardio-renal syndrome in uremic myocardiopathy animal model / Biomarcadores de síndrome cardiorrenal em modelo animal de miocardiopatia urêmica

ABSTRACT Introduction: Cardio-renal syndrome subtype 4 (CRS4) is a condition of primary chronic kidney disease that leads to reduction of cardiac function, ventricular hypertrophy, and risk of cardiovascular events. Objective: Our aim was to understand the mechanisms involved on the onset of CRS4. Methods: We used the nephrectomy 5/6 (CKD) animal model and compared to control (SHAM). Serum biomarkers were analyzed at baseline, 4, and 8 weeks. After euthanasia, histology and immunohistochemistry were performed in the myocardium. Results: Troponin I (TnI) was increased at 4 weeks (W) and 8W, but nt-proBNP showed no difference. The greater diameter of cardiomyocytes indicated left ventricular hypertrophy and the highest levels of TNF-α were found at 4W declining in 8W while fibrosis was more intense in 8W. Angiotensin expression showed an increase at 8W. Conclusions: TnI seems to reflect cardiac injury as a consequence of the CKD however nt-proBNP did not change because it reflects stretching. TNF-α characterized an inflammatory peak and fibrosis increased over time in a process connecting heart and kidneys. The angiotensin showed increased activity of the renin-angiotensin axis and corroborates the hypothesis that the inflammatory process and its involvement with CRS4. Therefore, this animal study reinforces the need for renin-angiotensin blockade strategies and the control of CKD to avoid the development of CRS4.

RESUMO Introdução: A síndrome cardiorrenal (SCR) tipo 4 é uma afecção da doença renal crônica primária que leva a redução da função cardíaca, hipertrofia ventricular e risco de eventos cardiovasculares. Objetivo: O objetivo do presente estudo foi compreender os mecanismos envolvidos no surgimento da SCR tipo 4. Métodos: Um modelo animal de nefrectomia 5/6 (DRC) foi comparado a animais de controle (Placebo). Biomarcadores séricos foram analisados no início do estudo e com quatro e oito semanas de estudo. Após eutanásia, foram realizados exames histológicos e de imunoistoquímica no tecido miocárdico. Resultados: Troponina I (TnI) estava aumentada nas semanas quatro (S4) e oito (S8), mas o NT-proBNP não apresentou diferenças. O diâmetro maior dos cardiomiócitos indicava hipertrofia ventricular esquerda. Os níveis mais elevados de TNF-α foram identificados na S4 com redução na S8, enquanto fibrose foi mais intensa na S8. A expressão de angiotensina mostrou elevação na S8. Conclusões: TnI parece sugerir lesões cardíacas em consequência da DRC, porém o NT-proBNP não sofreu alterações por refletir alongamento. O TNF-α evidenciou um pico inflamatório e a fibrose aumentou ao longo do tempo devido ao processo de conexão entre rins e coração. A angiotensina mostrou aumento da atividade do eixo renina-angiotensina, corroborando a hipótese do processo inflamatório e seu envolvimento com SCR tipo 4. Portanto, o presente estudo em modelo animal reforça a necessidade de em adotar estratégias com bloqueadores de renina-angiotensina e controle da DRC para evitar o desenvolvimento de SCR tipo 4.

The effect of hemodialysis on the body composition and cardiovascular disease markers in recently diagnosed end stage renal disease patients

SUMMARY AIM: Uremic toxins and excess fluid contributes to increased cardiovascular (CV) risk. We aimed to determine the body fluid status in patients who are just starting hemodialysis (HD) and to determine the effects of excess fluid removed by HD on the CV system. METHODS: A total of 52 patients with chronic kidney disease (CKD) who had just started HD were included. Before the HD, the left atrial diameter was measured, the volumes were calculated, the pulse wave velocity (PWV) and the augmentation index (AIx) were measured, the bioimpedance analysis (BIA) was performed, the blood was taken for brain natriuretic peptide (BNP). When patients reached their dry weight with HD, the same measurements were repeated. RESULTS: Measurements were made to determine the volume status, and all parameters except the fat tissue index decreased significantly after HD. With the removal of fluid by HD, there was an average weight reduction of 4.38 kilograms. Positive correlations between PWV and age and cardiothoracic ratio (CTR) before HD were determined. Negative correlations were found between PWV and lean tissue mass (LTM) and intracellular water (ICW) before HD. At the end of the last HD, PWV was positively correlated with age, CTR, central pulse pressure Correlation between pulse wave velocity and LTI was negative CONCLUSIONS: HD significantly improves PWV in patients reaching dry weight. Reduction of fluid excess by ultrafiltration in HD patients may reduce CV mortality by reducing arterial stiffness.

RESUMO INTRODUÇÃO: Em pacientes com doença renal crônica (DRC), toxinas urêmicas e hipervolemia contribuem para aumentar o risco cardiovascular. Nosso objetivo foi determinar o estado de hidratação em pacientes com DRC iniciando hemodiálise (HD) e avaliar os efeitos da correção da hipervolemia sobre o sistema cardiovascular. MÉTODOS: Foram incluídos 52 pacientes que haviam acabado de iniciar HD. Antes do início da sessão, foram determinados o diâmetro e o volume atrial esquerdo, a velocidade de onda de pulso (VOP) e o índice de amplificação sistólica ("augmentation index", AI). Além disso, realizamos análise da composição corporal por bioimpedância elétrica (BIA) e mensuramos os níveis plasmáticos de peptídeo natriurético tipo B. Os mesmos procedimentos foram repetidos após os pacientes alcançarem o "peso seco". RESULTADOS: O peso corporal dos pacientes foi reduzido, em média, em 4,38 kg. Na BIA, todos os parâmetros, exceto o índice de gordura corporal, foram significativamente reduzidos após a hemodiálise. Antes da HD, a VOP se correlacionou positivamente com idade e razão cardiotorácica (RCT), e negativamente com a massa magra e a água intracelular. Ao final da hemodiálise, a VOP se correlacionou positivamente com idade, RCTe pressão de pulso central, correlacionando-se negativamente com a Lean Tissue Index (LTI). CONCLUSÃO: A hemodiálise melhora a VOP por meio da redução da volemia. O controle da hipervolemia via ultrafiltração pode reduzir a mortalidade cardiovascular por meio da redução da rigidez arterial.

Natriuretic Peptide and Clinical Evaluation in the Diagnosis of Heart Failure Hemodynamic Profile: Comparison with Tissue Doppler Echocardiography / Peptídeo Natriurético e Avaliação Clínica no Diagnóstico do Perfil Hemodinâmico da Insuficiência Cardíaca: Comparação com Ecodopplercardiograma Tecidual

Abstract Background: Physical examination and B-type natriuretic peptide (BNP) have been used to estimate hemodynamics and tailor therapy of acute decompensated heart failure (ADHF) patients. However, correlation between these parameters and left ventricular filling pressures is controversial. Objective: This study was designed to evaluate the diagnostic accuracy of physical examination, chest radiography (CR) and BNP in estimating left atrial pressure (LAP) as assessed by tissue Doppler echocardiogram. Methods: Patients admitted with ADHF were prospectively assessed. Diagnostic characteristics of physical signs of heart failure, CR and BNP in predicting elevation (> 15 mm Hg) of LAP, alone or combined, were calculated. Spearman test was used to analyze the correlation between non-normal distribution variables. The level of significance was 5%. Results: Forty-three patients were included, with mean age of 69.9 ± 11.1years, left ventricular ejection fraction of 25 ± 8.0%, and BNP of 1057 ± 1024.21 pg/mL. Individually, all clinical, CR or BNP parameters had a poor performance in predicting LAP ≥ 15 mm Hg. A clinical score of congestion had the poorest performance [area under the receiver operating characteristic curve (AUC) 0.53], followed by clinical score + CR (AUC 0.60), clinical score + CR + BNP > 400 pg/mL (AUC 0.62), and clinical score + CR + BNP > 1000 pg/mL (AUC 0.66). Conclusion: Physical examination, CR and BNP had a poor performance in predicting a LAP ≥ 15 mm Hg. Using these parameters alone or in combination may lead to inaccurate estimation of hemodynamics.

Resumo Fundamento: Exame físico e peptídeo natriurético do tipo B (BNP) foram usados para estimar a hemodinâmica e adequar a terapia de pacientes com insuficiência cardíaca aguda descompensada (ICAD). Entretanto, correlação entre esses parâmetros e a pressão de enchimento do ventrículo esquerdo é controversa. Objetivo: Avaliar a acurácia diagnóstica do exame físico, da radiografia de tórax (RT) e do BNP para estimar a pressão atrial esquerda (PAE) avaliada pelo ecodopplercardiograma tecidual. Métodos: Pacientes admitidos com ICAD foram avaliados prospectivamente. As características diagnósticas dos sinais físicos de insuficiência cardíaca, RT e BNP para predizer elevação da PAE (> 15 mmHg), isolados ou combinados, foram calculadas. Teste de Spearman foi usado para analisar a correlação entre variáveis de distribuição não normal. O nível de significância foi 5%. Resultados: Este estudo incluiu 43 pacientes com idade média de 69,9 ± 11,1 anos, fração de ejeção ventricular esquerda de 25 ± 8.0%, e BNP de 1057 ± 1024,21 pg/mL. Individualmente, todos os parâmetros clínicos, RT e BNP apresentaram fraco desempenho para predizer PAE ≥ 15 mmHg. O escore clínico de congestão teve o pior desempenho [área sob a curva receiver operating characteristic (AUC) 0,53], seguindo-se escore clínico + RT (AUC 0,60), escore clínico + RT + BNP > 400 pg/mL (AUC 0,62) e escore clínico + RT + BNP > 1000 pg/mL (AUC 0,66). Conclusão: Exame físico, RT e BNP tiveram desempenho fraco para predizer PAE ≥15 mmHg. O uso desses parâmetros isoladamente ou em combinação pode levar a estimativa imprecisa do perfil hemodinâmico. (Arq Bras Cardiol. 2018; 110(3):270-277)

Síndrome de Bayés en cirugía cardiaca: prevalencia de bloqueo interauricular en menores de 65 años sometidos a cirugía cardiaca y su asociación con fibrilación auricular en el postoperatorio / Bayes' syndrome in cardiac surgery: prevalence of interatrial block in patients younger than 65 years undergoing cardiac surgery and association with postoperative atrial fibrillation

Resumen Objetivo: El bloqueo interauricular (BIA) es una entidad asociada con un mayor riesgo de presentar fibrilación auricular (FA), constituyendo el denominado síndrome de Bayés. El objetivo de nuestro estudio fue definir la prevalencia de BIA en pacientes menores de 65 años sometidos a cirugía cardiaca y determinar si existe una asociación entre la presencia de BIA y la aparición de FA postoperatoria. Método: Se incluyeron un total de 207 pacientes. Se definió BIA parcial como onda P > 120 ms. Se definió BIA avanzado como onda P > 120 ms con morfología bifásica en derivaciones inferiores. Se determinó la frecuencia de aparición de FA postoperatoria y se realizó un análisis comparativo entre los pacientes que presentaron y los que no presentaron esta arritmia. Resultados: La prevalencia de BIA fue del 78.3% (parcial, 66.2%; avanzado, 12.1%). La frecuencia de aparición de FA fue del 28.5% de forma global, siendo mayor en los pacientes con BIA avanzado (44%) comparado con pacientes con BIA parcial (27.7%) y sin BIA (24.4%). Los pacientes que presentaron FA fueron significativamente mayores, con niveles más elevados de NTproBNP y presentaron mayor prevalencia de dilatación auricular y de patología tiroidea. El análisis multivariable demostró una asociación independiente entre BIA avanzado y FA postoperatoria. Conclusiones: El BIA es una entidad frecuente en pacientes sometidos a cirugía cardiaca. En nuestro estudio, el BIA avanzado se asocia de forma independiente con una mayor frecuencia de FA postoperatoria en pacientes menores de 65 años sometidos a cirugía cardiaca.

Abstract Objective: Interatrial block (IAB) is a well-known entity that is associated with an increased risk of atrial fibrillation (AF). This association is called Bayes' syndrome. The aim of our study was to define the prevalence of IAB among patients younger than 65 years undergoing cardiac surgery and determine whether there is an association between the presence of interatrial conduction delay and postoperative atrial fibrillation (POAF). Method: A total of 207 patients were enrolled. Partial IAB was defined as P-wave > 120 ms. Advanced IAB was defined as P-wave > 120 ms + biphasic morphology in the inferior leads. Ocurrence of POAF was assessed and a comparative analysis was conducted between patients that did and did not develop AF. Results: IAB prevalence was 78.3% (partial 66.2%, advanced 12.1%). POAF occurred in 28.5% of all patients, and was more frequent among patients with advanced IAB (44%) compared to 27.7% and 24.4% of POAF among patients with partial IAB and without IAB, respectively. Patients who developed POAF were significantly older, had significantly higher NTproBNP, higher prevalence of atrial enlargement and thyroid disease. After multivariate analysis, advanced IAB was found to be independently associated with POAF. Conclusions: IAB is a frequent finding among patients undergoing cardiac surgery. According to our results, advanced IAB is independently associated with POAF in younger patients (< 65 years) undergoing cardiac surgery.

Relationship between brain natriuretic peptide and recurrence of atrial fibrillation after successful electrical cardioversion: an updated meta-analys

Abstract Objective: To investigate the relationship between brain natriuretic peptide and recurrence of atrial fibrillation after successful electrical cardioversion. Methods: Medline and Embase databases were used to identify publications evaluating BNP/N-Terminal (NT)-proBNP levels in association with atrial fibrillation recurrence after successful electrical cardioversion. Nineteen studies that fulfilled the specified criteria of our analysis were found. Results: Baseline BNP/NT-proBNP levels of the atrial fibrillation recurrence group were significantly higher than those of the sinus rhythm maintaining group (SMD -0.70, CI [-0.82, -0.58]). Conclusion: Our analysis suggests that low BNP/NT-proBNP levels are associated with sinus rhythm maintenance, and baseline BNP/NT-proBNP concentrations may be a predictor of atrial fibrillation recurrence after successful electrical cardioversion.

Incremental Prognostic Value of Conventional Echocardiography in Patients with Acutely Decompensated Heart Failure / Valor Prognóstico Incremental do Ecocardiograma Convencional em Pacientes com Insuficiência Cardíaca Agudamente Descompensada

Abstract Background: Acutely decompensated heart failure (ADHF) presents high morbidity and mortality in spite of therapeutic advance. Identifying factors of worst prognosis is important to improve assistance during the hospital phase and follow-up after discharge. The use of echocardiography for diagnosis and therapeutic guidance has been of great utility in clinical practice. However, it is not clear if it could also be useful for risk determination and classification in patients with ADHF and if it is capable of adding prognostic value to a clinical score (OPTIMIZE-HF). Objective: To identify the echocardiographic variables with independent prognostic value and to test their incremental value to a clinical score. Methods: Prospective cohort of patients consecutively admitted between January 2013 and January 2015, with diagnosis of acutely decompensated heart failure, followed up to 60 days after discharge. Inclusion criteria were raised plasma level of NT-proBNP (> 450 pg/ml for patients under 50 years of age or NT-proBNP > 900 pg/ml for patients over 50 years of age) and at least one of the signs and symptoms: dyspnea at rest, low cardiac output or signs of right-sided HF. The primary outcome was the composite of death and readmission for decompensated heart failure within 60 days. Results: Study participants included 110 individuals with average age of 68 ± 16 years, 55% male. The most frequent causes of decompensation (51%) were transgression of the diet and irregular use of medication. Reduced ejection fraction (<40%) was present in 47% of cases, and the NT-proBNP median was 3947 (IIQ = 2370 to 7000). In multivariate analysis, out of the 16 echocardiographic variables studied, only pulmonary artery systolic pressure remained as an independent predictor, but it did not significantly increment the C-statistic of the OPTMIZE-HF score. Conclusion: The addition of echocardiographic variables to the OPTIMIZE-HF score, with the exception of left ventricular ejection fraction, did not improve its prognostic accuracy concerning cardiovascular events (death or readmission) within 60 days

Resumo Fundamento: A insuficiência cardíaca agudamente descompensada (ICAD) apresenta elevada morbimortalidade a despeito do avanço terapêutico. Identificar fatores de pior prognóstico é importante para melhorar a assistência durante a fase hospitalar e acompanhamento após a alta. A utilização da ecocardiografia para diagnóstico e guia terapêutico tem sido de grande utilidade na prática clínica, contudo não está claro se também pode ser útil para determinação e classificação de risco desses pacientes e se é capaz de incrementar valor prognóstico a um escore clínico (OPTIMIZE-HF). Objetivo: Identificar as variáveis ecocardiográficas com valor prognóstico independente e testar seu valor incremental a um escore clínico. Métodos: Coorte prospectiva de pacientes consecutivamente admitidos entre janeiro de 2013 a janeiro de 2015, com diagnóstico de insuficiência cardíaca agudamente descompensada, acompanhados até 60 dias após a alta hospitalar. Os critérios de inclusão foram o aumento da dosagem plasmática do NT-proBNP (> 450 pg/ml para pacientes abaixo de 50 anos ou NT-proBNP > 900 pg/ml para pacientes acima de 50 anos) e pelo menos um dos sinais e sintomas: dispnéia em repouso, baixo débito cardíaco ou sinais de IC direita. O desfecho primário foi a combinação de óbito e reinternamento por insuficiência cardíaca descompensada em até 60 dias. Resultados: Foram estudados 110 indivíduos com média de idade 68 ± 16 anos, 55% do sexo masculino, sendo a transgressão da dieta/uso irregular de medicações a causa mais frequente de descompensação (51%). Fração de ejeção reduzida (< 40%) estava presente em 47% os casos, e a mediana do NT-proBNP era 3947 (IIQ = 2370 a 7000). Na análise multivariada, das 16 variáveis ecocardiográficas estudadas, somente a pressão sistólica de artéria pulmonar permaneceu como preditora independente, no entanto, não incrementou significativamente a estatística-C do escore OPTIMIZE-HF. Conclusão: A adição de variáveis ecocardiográficas, que não a fração de ejeção do ventrículo esquerdo, ao escore OPTIMIZE-HF, não melhorou a acurácia prognóstica do mesmo no que diz respeito a eventos cardiovasculares (morte ou re-hospitalização) em até 60 dias. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

B-Type natriuretic peptide as a predictor of short-term mortality in on-pump coronary artery bypass grafting

Abstract Objective: The present study refers to a determination of the preoperative B-type natriuretic peptide is a predictor of short-term all-cause mortality in patients undergoing on-pump coronary artery bypass graft surgeries. Methods: Two hundred and twenty-one patients undergoing on-pump coronary artery bypass graft surgeries were evaluated prospectively during a 30-day postoperative follow-up period. Serum B-type natriuretic peptide concentration was measured without a 24-hour period prior to the surgical procedure and the value obtained was correlated with a short-term all-cause mortality. Results: Data analysis showed that all-cause mortality rates were equal to 9.5% in 30 days. Accuracy analysis by the receiver operating characteristic curve found an ideal cut-off value of B-type natriuretic peptide equal to 150 pg/mL in relation to mortality (AUC=0.82, 95% CI=0.71-0.87, P<0.001). Multivariate analysis showed that B-type natriuretic peptide value greater than or equal to 150 pg/mL (P=0.030, HR=3.99, 95% CI=1.14-13.98) was an independent predictor of all-cause mortality in a 30-day follow-up period. Conclusion: Preoperative serum B-type natriuretic peptide concentration is an independent predictor of short-term all-cause mortality in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.

Changes in serum cardiac myosin light chain 1 levels in children with fulminant myocarditis during continuous blood purification

Summary Objective: To investigate the changes in serum cardiac myosin light chain 1 (CMLC-1) levels in children with fulminant myocarditis (FM) during continuous blood purification (CBP), as well as to analyze its correlation with other laboratory indexes. Method: Twenty-four (24) children with FM who underwent CBP were enrolled. Before and during treatment (48 and 72 hours after treatment, or death), the optical density value of serum CMLC-1 was measured using enzyme-linked immunosorbent assay, and then the serum CMLC-1 concentration was calculated. The correlations between CMLC-1 OD value change and laboratory indexes including creatine kinase-MB (CK-MB), troponin, myohemoglobin and N-terminal pro-brain natriuretic peptide (NT-proBNP) were analyzed. Results: The serum CMLC-1 concentration significantly increased in the children with FM and decreased obviously during CBP therapy. In the same period, the change of CMLC-1 concentration were positively correlated with creatine kinase-MB (r=0.528), troponin (r=0.726), myohemoglobin (r=0.702), and NT-proBNP levels (r=0.589). Conclusion: The serum CMLC-1 concentration increases significantly in children with FM, but CBP therapy can effectively control this increase.

Péptido natriurético tipo B: utilidad en el manejo de recién nacidos críticamente enfermos / B-type natriuretic peptide: Usefulness in the management of critically-ill neonates

El péptido natriurético B (PNB) es un péptido responsable de los cambios durante la organogénesis del corazón y en la transición a la vida extrauterina. En la primera semana de vida, los niveles de PNB son altos y se normalizan con el descenso fisiológico del peso. Valores elevados de PNB se han asociado a diferentes patologías. Objetivo. Establecer la relación entre los niveles de PNB y la criticidad y evolución a corto plazo en pacientes internados en la Unidad de Cuidados Intensivos Neonatales. Método. Estudio observacional analítico de una cohorte prospectiva. Se definió criticidad como requerimientos de asistencia respiratoria con fracción inspirada de oxígeno mayor del 50% y/o inotrópicos. Se extrajeron 2 muestras de sangre con 72 h de diferencia. Resultados. Ingresaron 73 pacientes. Según la evolución al séptimo día del ingreso, se los dividió en 2 grupos: pacientes con buena evolución o con evolución grave persistente. La mediana del PNB inicial fue similar en ambos grupos (p: 0,15). La mediana de PNB a las 72 h fue mayor en los pacientes con evolución grave persistente (p: 0,005). Se calculó la diferencia entre ambos valores de PNB (ΔPNB: valor de PNB a las 72 h - valor de PNB a la hora cero). El ΔPNB presentó valores positivos en los pacientes con evolución grave persistente (X= 1260 pg/ml; rango: 4262094) y valores negativos en el grupo con buena evolución (X= -967 pg/ml; rango: -1656/-278) (p: 0,0002); sensibilidad: 87%; especificidad: 86%; valor predictivo positivo: 74%; y valor predictivo negativo: 93%. Conclusión. En este grupo de pacientes, el delta de PNB reflejó la evolución a corto plazo.

B-type natriuretic peptide (BNP) is responsible for changes in the heart organogenesis and is associated with transition to extrauterine life. In the first week of life, BNP levels are high and return to normal with the physiological loss in weight. High BNP levels are associated with different conditions. Objective. To establish the relationship between BNP levels and criticality and the short-term clinical course among patients hospitalized in the neonatal intensive care unit. Method. Observational and analytical study conducted in a prospective cohort. Criticality was defined as a requirement for assisted mechanical ventilation with a fraction of inspired oxygen of more than 50% and/or inotropes. Two blood samples were collected 72 hours apart. Results. Seventy-three patients were included in the study. Depending on their clinical course on day 7, they were divided into 2 groups: patients with a good clinical course or a persistent, severe clinical course. The median baseline BNP level was similar in both groups (p: 0.15). The median BNP level at 72 hours was higher among patients with a persistent, severe clinical course (p: 0.005). The difference between both BNP values was calculated (ΔBNP: BNP level at 72 hours - BNP level at 0 hours). The ΔBNP was positive among patients with a persistent, severe clinical course (X= 1260 pg/mL; range: 426-2094) and negative in the group with a good clinical course (X= -967 pg/mL; range: -1656/-278) (p: 0.0002); sensitivity: 87%; specificity: 86%; positive predictive value: 74%; and negative predictive value: 93%. Conclusion. In this group of patients, the delta-BNP value reflected the short-term clinical course.

Galectina-3: experiencia en pacientes chilenos con diagnóstico de insuficiencia cardíaca descompensada / Galectin-3 levels in patients hospitalized for decompensated heart failure

Background: Galectin-3 (Gal-3) is a mediator of myocardial fibrosis involved in cardiac remodeling and a potential new prognosis marker in heart failure (HF). Aim: To measure Gal-3 at the moment of discharge in patients hospitalized for HF and its association with different variables. Material and Methods: Patients hospitalized for decompensated HF from four hospitals between August 2014 and March 2015, were included. Demographic, clinical and laboratory variables were recorded at the time of admission. At discharge, a blood sample was withdrawn to measure Gal-3 and brain natriuretic propeptide (Pro-BNP). Patients were separated in two groups, according to the level of Gal-3 (using a cutoff value of 17.8 ng/mL), comparing clinical and laboratory values between groups. Results: We included 52 patients with HF aged 70 ± 17 years (42% females). Functional capacity was III-IV in 46% of patients and the ejection fraction was 34.9 ± 13.4%. Pro-BNP values at discharge were 5,323 ± 8,665 pg/mL. Gal-3 values were 23.8 ± 16.6 ng/mL. Sixty percent of patients had values over 17.8 ng/mL. Those with elevated Gal-3 levels were older (75 ±16 and 62 ± 15 years, respectively, p = 0.025) and were hypertensive in a higher proportion (90.5% and 57.1% respectively, p = 0.021). Conclusions: In patients hospitalized for HF, Gal-3 levels are higher in older and hypertensive subjects.