The Changing Features of Plasma NT-proBNP Level in Patients With Hypertrophic Obstructive Cardiomyopathy After Alcohol Septal Ablation / 中国循环杂志

Objective: To explore the changing features of plasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) level in patients with hypertrophic obstructive cardiomyopathy (HCM) after alcohol septal ablation (ASA). Methods: A total of 82 HCM patients treated by ASA in our hospital were studied. According to plasmalevel of NT-proBNP, the patients were divided into 2 groups: High NT-proBNP group and Low NT-proBNP group,n=41 in each group. Plasma NT-proBNP was examined by ELISA; ventricular septal thickness (VST), left ventricular posterior wall thickness (LVPWT), maximal ventricular wall thickness (MLVWT) and left atrial diameter (LAD) were measured by echocardiography. There were 50 patients ifnished 1 year clinical or in-hospital follow-up, their NT-proBNP level and echocardiography were detected at 2 days and 1 year post-operation.The relationship between echocardiography parameter and NT-proBNP level was assessed; NT-proBNP was compared between pre- and 2 days, 1 year post-operation. Results:①In all 82 patients: compared with Low NT-proBNP group, High NT-proBNP group had increased VST (23.66±6.46) mm vs (20.79±4.56) mm,P=0.035, LVPWT (12.79±2.99) mm vs (11.50±2.35) mm,P=0.048, MLVWT (28.03±5.66) mm vs (25.18±4.81) mm,P=0.027 and LAD (40.73±4.86) mm vs (38.08±6.17) mm,P=0.049.②In 50 patients who ifnished 1 year follow-up study: compared with pre-operation, NT-proBNP level was slightly increased at 2 days post-operation (1841.79±1310.88) fmol/ml vs (1552.15±951.57) fmol/ml,P=0.066, while decreased at 1 year post-operation (1038.46±714.03) fmol/ml vs (1552.15±951.57) fmol/ml,P=0.000. Conclusion: Plasma NT-proBNP level was affected by atrial size and ventricular thickness in HCM patients, it may obviously decrease during long-term follow-up period.

The Prognostic Value of Serum Levels of Heart-Type Fatty Acid Binding Protein and High Sensitivity C-Reactive Protein in Patients With Increased Levels of Amino-Terminal Pro-B Type Natriuretic Peptide

BACKGROUND: Amino-terminal pro-B type natriuretic peptide (NT-proBNP) is a well-established prognostic factor in heart failure (HF). However, numerous causes may lead to elevations in NT-proBNP, and thus, an increased NT-proBNP level alone is not sufficient to predict outcome. The aim of this study was to evaluate the utility of two acute response markers, high sensitivity C-reactive protein (hsCRP) and heart-type fatty acid binding protein (H-FABP), in patients with an increased NT-proBNP level. METHODS: The 278 patients were classified into three groups by etiology: 1) acute coronary syndrome (ACS) (n=62), 2) non-ACS cardiac disease (n=156), and 3) infectious disease (n=60). Survival was determined on day 1, 7, 14, 21, 28, 60, 90, 120, and 150 after enrollment. RESULTS: H-FABP (P<0.001), NT-proBNP (P=0.006), hsCRP (P<0.001) levels, and survival (P<0.001) were significantly different in the three disease groups. Patients were divided into three classes by using receiver operating characteristic curves for NT-proBNP, H-FABP, and hsCRP. Patients with elevated NT-proBNP (≥3,856 pg/mL) and H-FABP (≥8.8 ng/mL) levels were associated with higher hazard ratio for mortality (5.15 in NT-proBNP and 3.25 in H-FABP). Area under the receiver operating characteristic curve analysis showed H-FABP was a better predictor of 60-day mortality than NT-proBNP. CONCLUSIONS: The combined measurement of H-FABP with NT-proBNP provides a highly reliable means of short-term mortality prediction for patients hospitalized for ACS, non-ACS cardiac disease, or infectious disease.

Correlation of Serum and Pericardial Fluid Amino Terminal Pro-B-type Natriuretic Peptide.

Objective: To investigate the correlation of pericardial fluid and serum NT-proBNP levels in patients during coronary artery bypass grafting (CABG). Study Design: Crossectional study. Place and Duration of the Study: This study was conducted over a period of one year from March 2010 to March 2011 in Physiology Department Ziauddin University, Clifton Karachi. Methodology: A crossectional study was done on 50 patients, undergoing CABG. Both the samples of serum and pericardial fluid were collected during CABG and NT-proBNP levels were assessed by an electrochemiluminescence immunoassay. The log transformation of NT-proBNP concentrations was done. We investigated the correlation of the pericardial fluid and serum levels of log NT-proBNP. Results: Pericardial fluid log NT-proBNP was estimated to be 2.7±0.54 pg/ml in contrast to a serum level of 2.2±0.6 pg/ml in 50 CABG patients. It was found that pericardial fluid NT-proBNP levels were significantly correlated with its serum levels with an r value of 0.85 and a p-value of < 0.0001. The pericardial fluid- serum ratio has been estimated to be 1.25. Conclusion: Serum NT-proBNP levels have significant correlation with its pericardial fluid levels. It can be used alone in the clinical practice provided kidneys function normally.

The value of NT-proBNP paired with Cys-C in early diagnosis of the type 1 cardiorenal syndrome / 中华急诊医学杂志

Objective To study the value of plasma amino-terminal pro-B-type natriuretic peptide precursor (NT-proBNP) along with cystatin C (Cys-C) used together in early diagnosis of the type 1 cardiorenal syndrome (CRS) in patients with acute heart failure.Methods From January 2011 to January 2014,the data of 395 acute heart failure patients in Wenzhou People' s Hospital were retrospectively analyzed.Plasma concentrations of NT-proBNP and Cys-C of 395 patients with acute heart failure were measured by using PETIA and ECLIA methods at about 24 hours after admission.And the incidence of type 1 CRS syndrome was analyzed by statistics.ROC analyses were performed to evaluate the early diagnosing value of plasma NT-proBNP along with Cys-C in determining type 1 CRS and in discerning the optimal cut-off point for early diagnosing type 1 CRS patients.Results A total of 395 patients with acute heart failure aged from 29-96 years with (74.3 ± 13.0) years in mean,and 61.3％ male were enrolled in this study.Of them,82 patients were suffered from CRS syndrome.Logistic regression analysis showed diabetes,chronic heart failure,Cys-C and NT-proBNP were independent risk factors for predicting type 1 CRS,and serum Cys-C level was the most important predictor.ROC analysis showed the areas under the curve (AUC) of plasma NT-proBNP and Cys-C for early diagnosing CRS were 0.835 (95％ CI:0.785-0.886,P ＜ 0.01) and 0.885 (95％ CI:0.825-0.944,P ＜0.01),respectively.The value of plasma NT-proBNP alone in early diagnosing the type 1 CRS was limited with Youden index up to 0.483.When the NT-proBNP paired with Cys-C,the diagnostic reliability has been greatly improved,especially specificity with Youden index up to 0.717.Therefore,NT-proBNP doupled with Cys-C has great reference value in early diagnosing the type 1 CRS.Conclusion Plasma NT-proBNP level coupled with Cys-C level is a valuable biomarker for early diagnosing type 1 cardio-renal syndrome in patients with acute heart failure.If the levels of plasma NT-proBNP and Cys-C are detected simultaneously,the diagnostic reliability of CRS will be greatly improved,especially in the diagnostic specificity.

Cut-off values of amino-terminal pro-B-type natriuretic peptide for the diagnosis of chronic heart failure in children of age stratification with congenital heart disease prior to heart surgery / 国际儿科学杂志

Objective To detect the plasma amino-terminal pro-B-type natriuretic peptide (NT-ProBNP) of children with congenital heart disease(CHD) prior to heart surgery,to analysize its sensitivity,specificity and Youden index by receiver operating characteristic(ROC) curve,to explore the cut-off values of plasma NTProBNP for the diagnosis of congestive heart failure(CHF) in children under 5 years old before and after age stratification.Method The plasma NT-proBNP was detected for 100 children with CHD prior to heart surgery (experimental group) and 100 normal children(control group) between January 2011 to January 2013.Age stratification(0 ～ 1 year group,～3 years group and ～ 5 year group) was conducted in children with CHF younger than 5 years old to explore the cut-off values of plasma NT-ProBNP for the diagnosis of CHF.Results The NT-proBNP of 34 patients with CHF(n =100) was in accordance to Ross criteria The cut-off values were 502 ng/ L before age stratification,and they were 552 ng/L,449 ng/L,349 ng/L after age stratification for 0 ～ 1 year group,～ 3 years group and ～ 5 group.Conclusion The cut-off values of plasma NT-ProBNP for CHF were 552 ng/L、449 ng/L、349 ng/L for 0 ～ 1 year group,～ 3 years group and ～ 5 year group.

The diagnostic and predictive value of amino-terminal pro-B-type natriuretic peptide (NT-proBNP)testing in patients with acute dyspnea / 中华急诊医学杂志

Objective To study the diagnostic and predictive values of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients presenting acute dyspnea. Method A total of 533 patients with dyspnea were studied. According to the clinical characteristics and echocardiographic findings, the patients were divided into two groups, namely acute congestive heart failure group (ACHF) and non-ACHF group. NT-proBNP levels were assayed in all patients in order to evaluate the diagnostic value, and predictive value in patients of ACHF group by following up study to know the clinical destination of patients to be cardiac death or re-admission into hospital. Results There were 272 ACHF patients and 261 non-ACHF patients, and the levels of NT-proBNT were significantly different between two groups ( 2683.4±86.9) pg/mL vs. (238.6+8.7) pg/mL, P＜0.01) . A total of 220 patients were followed for 158 ±32. 8 days. The level of NT-proBNT in myocardium of patients in re-admission group was 2683 + 86. 9 pg/mL and in death group was 3283.4 + 105.7 pg/mL which both were higher than that in patients without cardiac events ( 1123. 5 + 72. 1 pg/mL) ( P ＜0. 01 ) . By using multivariate Cox analysis, log NT-proBNT was ( r = 0. 987, P = 0. 002), and atrial fibrillation (r = 0. 876, P = 0. 005 ) and ventriculat tachycardia ( r=0. 891, P =0. 005) were the valid predictors of cardiac events. Conclusions Routine determination of NT-proBNT in Emergency Department should be useful for quickly sorting patients with acute dyspnea. The NT-proBNT could be used as a good prognostic indicator of ACHF. In addition, log NT-proBNT and atrial fibrillation, ventricular tachycardia were the independent risk factors of cardiac events.