Steady-State Levels of Troponin and Brain Natriuretic Peptide for Prediction of Long-Term Outcome after Acute Heart Failure with or without Stage 3 to 4 Chronic Kidney Disease.

Aim: To determine whether assessment of a combination of steady-state discharge levels of biomarkers improves risk stratification after acute decompensate HF. Study Design: Retrospective cohort study. Place and Duration of Study: Keio University Hospital, between January 2006 and September 2011. We analyzed 244 patients with acute HF due to ischemic or dilated cardiomyopathy who were enrolled in a prospective, single institution-based registry between January 2006 and September 2011. Patients were stratified by discharge values of BNP and/or TnT. The primary endpoint was a composite of HF readmission or death during the 2-year period after discharge. Results: The population was predominantly male (69.3%), and the mean age was 66.6±15.3 years. Patients with higher BNP levels or detectable TnT had a worse prognosis (BNP45.0% vs. 18.8%, p<0.001; TnT 43.8% vs. 25.1%, p=0.002, respectively). The primary event rate was additively worse among patients with both increased BNP levels and detectable TnT compared to those with increased levels of BNP or detectable TnT alone (log-rank p<0.001). A similar trend was observed in the subgroup of patients with CKD stage III–V (n=172). Conclusion: Assessment of both BNP and TnT values may have a significant predictive value for HF prognosis, even among patients with CKD, a condition affecting biomarker levels.

Strategies for ensuring that regenerative cardiomyocytes function properly and in cooperation with the host myocardium

In developed countries, in which people have nutrient-rich diets, convenient environments, and access to numerous medications, the disease paradigm has changed. Nowadays, heart failure is one of the major causes of death. In spite of this, the therapeutic efficacies of medications are generally unsatisfactory. Although whole heart transplantation is ideal for younger patients with heart failure, many patients are deemed to be unsuitable for this type of surgery due to complications and/or age. The need for therapeutic alternatives to heart transplantation is great. Regenerative therapy is a strong option. For this purpose, several cell sources have been investigated, including intrinsic adult stem or progenitor cells and extrinsic pluripotent stem cells. Most intrinsic stem cells seem to contribute to a regenerative environment via paracrine factors and/or angiogenesis, whereas extrinsic pluripotent stem cells are unlimited sources of cardiomyocytes. In this review, we summarize the various strategies for using regenerative cardiomyocytes including our recent progressions: non-genetic approaches for the purification of cardiomyocytes and efficient transplantation. We expect that use of intrinsic and extrinsic stem cells in combination will enhance therapeutic effectiveness.