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1.
Kardiologiia ; 59(8): 5-14, 2019 Aug 08.
Artigo em Russo | MEDLINE | ID: mdl-31397225

RESUMO

BACKGROUND: Recently lung ultrasound (LUS) based on B-lines measurement has been proposed as an effective tool for assessment of pulmonary congestion (PC) in patients with decompensated heart failure (DHF). OBJECTIVE: to assess the incidence, in-hospital changes and prognostic significance of PC assessed by LUS in DHF patients. MATERIALS AND METHODS: Routine clinical assessment and eight-zone LUS were performed in 162 patients with DHF (men 66%, mean age 68±12 years, hypertension 97%, history of myocardial infarction 44%, atrial fibrillation 60%, ejection fraction [EF] 40±14%, EF<40% 46%, baseline NT-proBNP 4 246 [1741; 6 837] pg/ml). Sum of B-lines ≤5 was considered as normal, 6-15, 16-30 and >30 - as mild, moderate and severe PC, respectively. RESULTS: Using LUS on admission PC was diagnosed in all patients (moderate and severe in 31.5 and 67.3%, respectively). At discharge normal LUS profile was observed in 48.2% of patients. In 33.3, 14.8 and 3.7% of patients PC was mild, moderate, and severe, respectively. According to multivariable Cox regression analysis including age, sex, EF, NYHA functional class, and jugular venous distension sum of B-lines >5 at discharge was associated with higher probability of 12-month all-cause death (hazard ratio [HR] 2.86, 95% confidence interval [CI] 1.15-7.13, p=0.024), sum of B-lines >15 - with higher probability of HF readmission (HR 2.83, 95%CI 1.41-5.67, p=0.003). CONCLUSION: During hospital stay the incidence of PC as assessed by LUS decreased from 100 to 52% of patients. Sum of B-lines >5 at discharge was independently associated with higher risk of 12-month all-cause death, >15 - with higher risk of 12-month HF readmission.


Assuntos
Insuficiência Cardíaca , Edema Pulmonar , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pulmão , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico , Prognóstico , Edema Pulmonar/diagnóstico por imagem , Ultrassonografia
2.
Medicine (Baltimore) ; 98(29): e16507, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335723

RESUMO

BACKGROUND: To analyze whether BNP could be a potential biomarker for cardiac damage of breast cancer after radiotherapy. METHODS: PubMed, Web of Science, ProQuest and Medline were searched using the key words "breast cancer" ("breast tumor", "breast neoplasm", or "breast carcinoma"), "brain natriuretic peptide" (or BNP) and "radiotherapy" (or "radiation therapy"). Four articles were selected and analyzed using the STATA 12.0 software package. The standard mean difference (SMD) and its standard error for BNP were calculated to assess the relationship between BNP and radiotherapy for breast cancer patients. RESULTS: In total, 172 patients with breast cancer were identified. The pooled SMD was -0.233 (95% CI -1.113, -0.057). The pooled estimated SMD for all studies showed obvious significant difference (z = 3.99, P = .000). There was no publication bias. CONCLUSIONS: This meta-analysis suggested that BNP could be a biomarker of cardiac damage at high heart absorbed doses according to radiotherapy, especially for left breast cancer patients.


Assuntos
Neoplasias da Mama/radioterapia , Cardiotoxicidade/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Biomarcadores/sangue , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante , Feminino , Humanos , Mastectomia , Radioterapia Adjuvante/efeitos adversos
3.
Kardiologiia ; 59(6S): 41-50, 2019 Jul 24.
Artigo em Russo | MEDLINE | ID: mdl-31340748

RESUMO

PURPOSE OF THE STUDY: Analyze the parameters of the interaction between the left ventricle and the arterial system in patients with chronic forms of coronary heart disease and to identify relationships with levels of proadrenomedullin (MR­proADM) and N­terminal precursor of the brain natriuretic peptide B (NT­proBNP). MATERIALS AND METHODS: 240 patients with chronic forms of coronary heart disease (median - 55,9 [43; 63] years) and Q­forming myocardial infarction in the past were examined. Of these, 110 patients with myocardial infarction and preserved lef ventricular ejection fraction and 130 patients with ischemic cardiomyopathy. All patients were calculated parameters of lef ventricular­arterial interaction and the determination in blood serum levels of MR­proADM and NT­proBNP. RESULTS: In patients with ischemic cardiomyopathy, an increase in the lef ventricular­arterial interaction index was detected (2,51 [1,18; 5,00]), which reflects a decrease in the functional abilities and efficiency of the heart. In patients with myocardial infarction and a preserved left ventricular ejection fraction, this indicator was in the range of normal values (0,78 [0,55; 1,07]), which indicates an effective cardiac work. A study of MR­proADM and NT­proBNP levels demonstrated an increase in both groups (1,72 [1,56; 1,98] nmol/l and 779,3 [473; 2193] pg/ml in the group of patients with ischemic cardiomyopathy; 0,89 [0,51; 1,35] nmol/l and 246 [118; 430] pg/ml in the group of patients with myocardial infarction and preserved left ventricular ejection fraction), and the correlation analysis with left ventricular­arterial coupling interaction parameters allowed identify statistically significant connections (in the group of patients with ischemic cardiomyopathy: with the level of MR­proADM ­ r=0,67, p=0,006, with the level of NT­proBNP ­ r=0,78, p<0,001; in the group of patients with myocardial infarction and preserved left ventricular ejection fraction: with MR­proADM level ­ r=­0,52, p=0,024, with NT­proBNP level ­ r =­0,38, p=0,037). CONCLUSION: The findings suggest a pathogenetic association between the biomarkers under study and the parameters of left ventricular­arterial coupling interaction.


Assuntos
Infarto do Miocárdio , Isquemia Miocárdica , Adulto , Biomarcadores , Ventrículos do Coração , Humanos , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Volume Sistólico , Função Ventricular Esquerda
4.
Medicine (Baltimore) ; 98(30): e16566, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348283

RESUMO

RATIONALE: Cardiac transthyretin amyloidosis is a progressive and fatal cardiomyopathy for which several promising therapies are in development. The diagnosis is frequently delayed or missed because of the limited specificity of clinical manifestations, routine electrocardiogram, echocardiography and the traditional requirement for endomyocardial biopsy confirmation. PATIENT CONCERNS: A 68-year-old female had suffered from lumbago for 5 years with progressive weakness, numbness in both lower limb. DIAGNOSIS: The patient's clinical signs were not specific, but cardiac amyloidosis was suspected based on relative left ventricular apical sparing of longitudinal strain on echocardiography and continuous elevated serum levels of cardiac biomarkers (ultrasensitive cardiac troponin I and NT-proBNP). She was finally diagnosed hereditary transthyretin-related cardiac amylodosis by specific findings of cardiovascular magnetic resonance imaging (CMR), -technetium pyrophosphate (Tc-PYP) scintigraphy and genetic testing. INTERVENTIONS: The patient received medications including diuretics, beta-blockers and angiotensin-converting enzyme inhibitors at the time of hospitalization. Ultimately, however, she refused further treatments and requested discharge from our hospital. OUTCOMES: A series of noninvasive technique enables the diagnosis of hereditary transthyretin-related cardiac amyloidosis. LESSONS: While endomyocardial biopsy is not able to performed, this case demonstrates that a combination of noninvasive techniques, especially CMR, nuclear imaging, and genetic testing, may help us to make a correct diagnosis of hereditary transthyretin-related cardiac amyloidosis.


Assuntos
Neuropatias Amiloides Familiares/diagnóstico , Técnicas de Imagem Cardíaca/métodos , Testes Genéticos/métodos , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Troponina I/sangue , Idoso , Ecocardiografia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Cintilografia/métodos , Compostos Radiofarmacêuticos , Pirofosfato de Tecnécio Tc 99m
5.
World J Pediatr Congenit Heart Surg ; 10(4): 446-453, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307305

RESUMO

BACKGROUND: Very little is known about clinical and biomarker predictors of readmissions following pediatric congenital heart surgery. The cardiac biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) can help predict readmission in adult populations, but the estimated utility in predicting risk of readmission or mortality after pediatric congenital heart surgery has not previously been studied. Our objective was to evaluate the association between pre- and postoperative serum biomarker levels and 30-day readmission or mortality for pediatric patients undergoing congenital heart surgery. METHODS: We measured pre- and postoperative NT-proBNP levels in two prospective cohorts of 522 pediatric patients <18 years of age who underwent at least one congenital heart operation from 2010 to 2014. Blood samples were collected before and after surgery. We evaluated the association between pre- and postoperative NT-proBNP with readmission or mortality within 30 days of discharge, using multivariate logistic regression, adjusting for covariates based on the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Mortality Risk Model. RESULTS: The Johns Hopkins Children's Center cohort and the Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) cohort demonstrate event rates of 12.9% and 9.4%, respectively, for the composite end point. After adjustment for covariates in the STS congenital risk model, we did not find an association between elevated levels of NT-proBNP and increased risk of readmission or mortality following congenital heart surgery for either cohort. CONCLUSIONS: In our two cohorts, preoperative and postoperative values of NT-proBNP were not significantly associated with readmission or mortality following pediatric congenital heart surgery. These findings will inform future studies evaluating multimarker risk assessment models in the pediatric population.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/sangue , Peptídeo Natriurético Encefálico/sangue , Readmissão do Paciente/tendências , Fragmentos de Peptídeos/sangue , Medição de Risco/métodos , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Seguimentos , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Mortalidade Hospitalar/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Maryland/epidemiologia , Alta do Paciente/tendências , Período Pós-Operatório , Prognóstico , Precursores de Proteínas , Estudos Retrospectivos , Taxa de Sobrevida/tendências
6.
Clin Biochem ; 70: 34-38, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31173734

RESUMO

BACKGROUND AND AIMS: The release of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is strongly triggered by myocardial ischemia. We aimed to investigate whether the addition of NT-proBNP to high-sensitivity cardiac troponin (hs-cTnI) at presentation could provide better performance in risk stratification and thus early rule-out of acute myocardial infarction (AMI) in patients of the "observe zone". METHODS: Emergency department (ED) patients presenting with symptoms suspicious for AMI were consecutively enrolled. Blood samples were obtained at presentation and tested for hs-cTnI and NT-proBNP. All available medical records pertaining to the patient from ED presentation to 30-day follow-up were used for adjudication of the primary outcome. The incremental diagnostic value added by NT-proBNP to hs-cTnI was evaluated by receiver operating characteristic (ROC) analysis, continuous net reclassification improvement (cNRI), and integrated discrimination improvement (IDI). Sensitivity, specificity, positive and negative predictive values were used to assess the diagnostic accuracy of different approaches for early rule out. RESULTS: Of the 165 patients we analyzed, 55 (33.3%) had index AMI. For hs-cTnI alone, area under the curve for index AMI was not significantly increased after adding NT-proBNP (0.773 vs 0.809; p = .076). Adjustment of hs-cTnI by NT-proBNP improved the predictive value of hs-cTnI, showed by cNRI (0.418, 95%CI 0.102-0.735, p = .009) and IDI (0.055, 95%CI 0.017-0.092, p = .004). Compared to hs-cTnI, the combined test identified 14% more patients as low-risk and safe for early discharge. CONCLUSIONS: Combination of presentation hs-cTnI and NT-proBNP provided better predictive performance for AMI in patients of the observe zone presenting with symptoms of chest pain as compared to hs-cTnI alone. The combined test outperformed hs-cTnI by correctly identifying nearly 14% more patients as low-risk and safe for early discharge. Future multi-center studies are needed to verify the results and to determine the best clinical use of the combination of NT-proBNP and hs-cTnI in the early diagnosis of AMI.


Assuntos
Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Troponina I/sangue , Idoso , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
Int J Cardiovasc Imaging ; 35(7): 1265-1275, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31165941

RESUMO

Assessment of global longitudinal strain (GLS) is superior to ejection fraction (EF) in the evaluation of left ventricular (LV) function in patients with stable coronary artery disease (CAD). However, the role of mechanical dispersion (MD) in this context remains unresolved. We aimed to evaluate the potential role of MD as a marker of LV dysfunction and long-term prognosis in stable CAD. EF, GLS and MD were assessed in 160 patients with stable CAD, 1 year after successful coronary revascularization. Serum levels of high-sensitivity cardiac troponin I (hs-cTnI) and amino-terminal pro B-type natriuretic peptide (NT-proBNP) were quantified as surrogate markers of LV dysfunction. The primary endpoint was defined as all-cause mortality, the secondary endpoint was defined as the composite of all-cause mortality and hospitalization for acute myocardial infarction or heart failure during follow-up. Whereas no associations between EF and the biochemical markers of LV function were found, both GLS and MD correlated positively with increasing levels of hs-cTnI (R = 0.315, P < 0.001 and R = 0.442, P < 0.001, respectively) and NT-proBNP (R = 0.195, P = 0.016 and R = 0.390, P < 0.001, respectively). Median MD was 46 ms (interquartile range [IQR] 37-53) and was successfully quantified in 96% of the patients. During a median follow-up of 8.4 (IQR 8.2-8.8) years, 14 deaths and 29 secondary events occurred. MD was significantly increased in non-survivors, and provided incremental prognostic value when added to EF and GLS. NT-proBNP was superior to the echocardiographic markers in predicting adverse outcomes. MD may be a promising marker of LV dysfunction and adverse prognosis in stable CAD.


Assuntos
Doença da Artéria Coronariana/cirurgia , Ecocardiografia , Revascularização Miocárdica , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Biomarcadores/sangue , Causas de Morte , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/mortalidade , Peptídeo Natriurético Encefálico/sangue , Readmissão do Paciente , Fragmentos de Peptídeos/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Troponina I/sangue , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/terapia
8.
Ann Hematol ; 98(7): 1561-1572, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31098737

RESUMO

Sickle cell disease (SCD), a hereditary form of chronic hemolytic anemia, is characterized by acute vascular occlusion and chronic complications as pulmonary hypertension (PH), a hallmark of higher mortality. This study aimed to determine peripheral blood expression of superoxide dismutase 2 (SOD2), a major mitochondrial antioxidant enzyme in SCD patients on the mRNA level and compared it with SOD2 expression in healthy individuals. It also aimed to detect possible differences in SOD2 expression among patients with/without specific SCD complications and to detect possible correlations with patient laboratory parameters. SOD2 mRNA levels were significantly lower in SCD patients in comparison with controls and correlated with red blood cell count, reticulocyte count, platelet count, C-reactive protein, ferritin, and brain natriuretic peptide values. SCD patients with echocardiographic indications of PH featured significantly reduced SOD2 expression in comparison with patients without such indications. Consequently, SOD2 expression emerges as a potential biomarker of PH in SCD being a link among hemolysis, inflammation, iron overload, oxidative stress, and SCD cardiopathy.


Assuntos
Anemia Falciforme/enzimologia , Regulação Enzimológica da Expressão Gênica , Superóxido Dismutase/sangue , Adulto , Anemia Falciforme/patologia , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Feminino , Ferritinas/sangue , Humanos , Masculino , Peptídeo Natriurético Encefálico/sangue , Contagem de Plaquetas , Contagem de Reticulócitos
9.
Rev Med Chil ; 147(2): 145-152, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31095161

RESUMO

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.


Assuntos
Volume Plaquetário Médio , Tromboembolia Venosa/mortalidade , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Plaquetas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Neoplasias/complicações , Fragmentos de Peptídeos/sangue , Prognóstico , Embolia Pulmonar/sangue , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sepse/complicações , Análise de Sobrevida , Troponina/sangue , Tromboembolia Venosa/sangue , Tromboembolia Venosa/complicações , Trombose Venosa/sangue , Trombose Venosa/mortalidade
10.
Int J Mol Sci ; 20(9)2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31072047

RESUMO

C-type natriuretic peptide (CNP) is an autocrine and paracrine mediator released by endothelial cells, cardiomyocytes and fibroblasts that regulates vital physiological functions in the cardiovascular system. These roles are conveyed via two cognate receptors, natriuretic peptide receptor B (NPR-B) and natriuretic peptide receptor C (NPR-C), which activate different signalling pathways that mediate complementary yet distinct cellular responses. Traditionally, CNP has been deemed the endothelial component of the natriuretic peptide system, while its sibling peptides, atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), are considered the endocrine guardians of cardiac function and blood volume. However, accumulating evidence indicates that CNP not only modulates vascular tone and blood pressure, but also governs a wide range of cardiovascular effects including the control of inflammation, angiogenesis, smooth muscle and endothelial cell proliferation, atherosclerosis, cardiomyocyte contractility, hypertrophy, fibrosis, and cardiac electrophysiology. This review will focus on the novel physiological functions ascribed to CNP, the receptors/signalling mechanisms involved in mediating its cardioprotective effects, and the development of therapeutics targeting CNP signalling pathways in different disease pathologies.


Assuntos
Etanolaminas/metabolismo , Miocárdio/metabolismo , Peptídeo Natriurético Tipo C/genética , Comunicação Parácrina/genética , Fenetilaminas/metabolismo , Fator Natriurético Atrial/genética , Sistema Cardiovascular/metabolismo , Sistema Cardiovascular/patologia , Células Endoteliais/metabolismo , Humanos , Miócitos Cardíacos/metabolismo , Peptídeo Natriurético Encefálico/genética , Peptídeo Natriurético Tipo C/metabolismo , Receptores do Fator Natriurético Atrial/genética
11.
Zhongguo Zhong Yao Za Zhi ; 44(8): 1642-1647, 2019 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-31090329

RESUMO

This paper was aimed to investigate the inhibitory effect of aconitine(AC) on angiotensin Ⅱ(Ang Ⅱ)-induced H9 c2 cell hypertrophy and explore its mechanism of action. The model of hypertrophy was induced by Ang Ⅱ(1×10-6 mol·L-1),and cardiomyocytes were incubated with different concentrations of AC. Western blot was used to quantify the protein expression levels of atrial natriuretic peptide(ANP),brain natriuretic peptide(BNP),ß-myosin heavy chain(ß-MHC),and α-smooth muscle actin(α-SMA). Real-time quantitative PCR(qRT-PCR) was used to quantify the mRNA expression levels of cardiac hypertrophic markers ANP,BNP and ß-MHC. In addition,the fluorescence intensity of the F-actin marker,an important component of myofibrils,was detected by using laser confocal microscope. AC could significantly reverse the increase of total protein content in H9 c2 cells induced by Ang Ⅱ; qRT-PCR results showed that AC could significantly inhibit the ANP,BNP and ß-MHC mRNA up-regulation induced by AngⅡ. Western blot results showed that AC could significantly inhibit the ANP,BNP and ß-MHC protein up-regulation induced by AngⅡ. In addition,F-actin expression induced by Ang Ⅱ could be inhibited by AC,and multiple indicators of cardiomyocyte hypertrophy induced by Ang Ⅱ could be down-regulated,indicating that AC may inhibit cardiac hypertrophy by inhibiting the expression of hypertrophic factors,providing new clues for exploring the cardiovascular protection of AC.


Assuntos
Aconitina/farmacologia , Angiotensina II , Miócitos Cardíacos/efeitos dos fármacos , Actinas/metabolismo , Fator Natriurético Atrial/metabolismo , Miosinas Cardíacas/metabolismo , Cardiomegalia , Células Cultivadas , Humanos , Hipertrofia , Cadeias Pesadas de Miosina/metabolismo , Peptídeo Natriurético Encefálico/metabolismo
12.
Mymensingh Med J ; 28(2): 333-346, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31086148

RESUMO

Heart failure is a major public health issue with a current prevalence of over 23 million worldwide. Epidemiologic studies suggest that nearly one-half of patients with heart failure have a normal ejection fraction that is now termed HFpEF. Prevalence of HFpEF is approximately 50% (range 40-71%). Most pathophysiologic abnormalities in patients with HFpEF are related to diastolic function. Doppler echocardiography is the choice of investigation for evaluation of Diastolic function. Tissue Doppler Imaging is a new dimension in this concept. Natriuretitic peptides are widely accepted biomarker in HFrEF patients. Now a days, it is also considered for HFpEF patients for diagnostic & prognostic purpose. Aim of this study was to find out the association of Diastolic dysfunction with N-terminal Pro B-type Natriuretic Peptide level in HFpEF patients. This cross-sectional analytical study was conducted in the department of Cardiology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from October 2016 to September 2017. Total 120 HFpEF patients were included after considering inclusion and exclusion criteria. Sample population was divided into two groups, Group I: HFpEF patients with normal Diastolic function. Group II: HFpEF patients with diastolic dysfunction in this study mean NT-pro BNP value of Group I and Group II were 104.07±7.2pg/ml and 943.19±112.51pg/ml respectively, which was statistically significant (p value <0.05). Among the echocardiographic parameters LV hypertrophy, Left atrial volume index (LAVI), TDI derived mitral annular velocity, e' septal velocity, E/e' (septal) ratio, Decelaration time were statistically significant. In this study, it was also shown that the levels of NT-proBNP had positive correlation with Doppler parameters. Statistically significant moderate positive correlation was observed between NT-proBNP level and LAVI value, correlation coefficient (r=0.553, p=0.001) suggesting that the higher the level of NT Pro BNP level, the higher value of the LAVI value. Statistically significant moderate positive correlation was also observed between NT-proBNP level and E/e' (septal), correlation coefficient (r=0.526, p=0.001) suggesting that the higher the level of NT Pro BNP level, the Higher value of the E/e' (septal) value in HFpEF patients with diastolic dysfunction. In subgroup analysis of Group II ,mean NT-proBNP level showed affirmative relation with severity of diastolic dysfunction grades ranging from grade I (340.76±24.42) to grade III (3727.83±306.50) Diastolic dysfunction is associated with elevated NT-proBNP level in HFpEF patients & NT-proBNP value rises with gradual deterioration of Diastolic dysfunction among the HFpEF patients.


Assuntos
Insuficiência Cardíaca/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/sangue , Função Ventricular Esquerda/fisiologia , Bangladesh , Biomarcadores , Estudos Transversais , Insuficiência Cardíaca/complicações , Humanos
13.
J Vet Emerg Crit Care (San Antonio) ; 29(3): 256-263, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034737

RESUMO

OBJECTIVE: To measure plasma N-terminal fragments of pro-B-type natriuretic peptides (NT-proBNP) and cardiac troponin T (cTnT) concentration in hospitalized dogs and relate these markers to underlying conditions and evaluate their potential as prognostic markers in dogs with systemic inflammatory response syndrome (SIRS). DESIGN: Prospective, observational, clinical study. SETTING: Emergency department of a university teaching hospital. ANIMALS: Sixty-nine dogs with SIRS examined in the emergency department were prospectively studied. Patient age ranged from 5 months to 15 years, and weight ranged from 5.5 to 75 kg. MEASUREMENTS AND MAIN RESULTS: Blood samples were obtained at presentation, during hospitalization until discharge or death, and at a "control" visit (T1m) at least 1 month after hospital discharge. NT-proBNP was assayed with a commercially available canine ELISA, while cTnT was measured with an automated immunoassay previously used in dogs. A correlation procedure, mixed procedure on a linear model, and a logistic procedure were performed. Forty-four patients survived, 19 of which had control visits. cTnT concentrations were significantly higher than T0 and T1m at T12, T24, and T72. In 28 dogs, cTnT was detected during hospitalization, but cTnT was not detected in any dog at the control visits. Higher concentrations of cTnT were negatively associated with survival, irrespective of disease category. NT-proBNP concentrations were significantly higher than T0, T6, T12, and T1m at T24, T72, and T120, but were not associated with survival. CONCLUSIONS: NT-proBNP and cTnT increased significantly in dogs with SIRS, regardless of the underlying disease process. Nonsurvivors displayed significantly higher cTnT concentrations during hospitalization.


Assuntos
Biomarcadores/sangue , Doenças do Cão/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Síndrome de Resposta Inflamatória Sistêmica/veterinária , Troponina T/sangue , Animais , Cuidados Críticos , Cães , Feminino , Masculino , Prognóstico , Estudos Prospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue
14.
Int Heart J ; 60(3): 701-707, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31019174

RESUMO

Fractalkine has been reported to play an important role in the pathophysiology of various cardiovascular disorders. This research aims to study the change of soluble fractalkine (sFKN) in plasma level of patients with chronic heart failure (CHF) and evaluate its prognostic value.A total of 96 patients with CHF and 45 healthy subjects were included in this study. The plasma levels of sFKN, brain natriuretic peptide (BNP), and Interleukin-18 (IL-18) were determined by ELISA kits when they were first admitted to the hospital. Left ventricular ejection fraction (LVEF) was measured by echocardiogram. Rehospitalization status within 1 year after the first hospitalization was also recorded.The plasma levels of sFKN, BNP, and IL-18 in patients with CHF were significantly higher than in the control group (P < 0.05). The concentrations of sFKN and BNP were increased with the severity of heart failure classified by NYHA classification (P < 0.05). There were no statistical differences among all CHF subgroups classified by etiology (P > 0.05). Plasma sFKN level in CHF group was positively correlated with BNP (r = 0.441, P < 0.001) and IL-18 (r = 0.592, P < 0.001). Receiver operating characteristic curve analysis showed that area under the curve values of FKN, BNP, and IL-18 were 0.885 (95%CI: 0.810 to 0.960, P < 0.001), 0.889 (95%CI: 0.842 to 0.956, P < 0.001), and 0.878 (95%CI: 0.801-0.954, P < 0.001), respectively. The concentrations of sFKN and BNP were increased in patients readmitted more than once within 1 year (P < 0.05).


Assuntos
Quimiocina CX3CL1/sangue , Insuficiência Cardíaca/sangue , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto , Idoso , Quimiocina CX3CL1/metabolismo , Doença Crônica , Ecocardiografia/métodos , Feminino , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/mortalidade , Humanos , Interleucina-18/sangue , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Readmissão do Paciente/estatística & dados numéricos , Prognóstico , Índice de Gravidade de Doença
15.
Cardiovasc Diabetol ; 18(1): 45, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30935417

RESUMO

BACKGROUND: Sodium glucose co-transporter 2 inhibitor (SGLT2i), a new class of anti-diabetic drugs acting on inhibiting glucose resorption by kidneys, is shown beneficial in reduction of heart failure hospitalization and cardiovascular mortality. The mechanisms remain unclear. We hypothesized that SGLT2i, empagliflozin can improve cardiac hemodynamics in non-diabetic hypertensive heart failure. METHODS AND RESULTS: The hypertensive heart failure model had been created by feeding spontaneous hypertensive rats (SHR) with high fat diet for 32 weeks (total n = 13). Half SHRs were randomized to be administered with SGLT2i, empagliflozin at 20 mg/kg/day for 12 weeks. After evaluation of electrocardiography and echocardiography, invasive hemodynamic study was performed and followed by blood sample collection and tissue analyses. Empagliflozin exhibited cardiac (improved atrial and ventricular remodeling) and renal protection, while plasma glucose level was not affected. Empagliflozin normalized both end-systolic and end-diastolic volume in SHR, in parallel with parameters in echocardiographic evaluation. Empagliflozin also normalized systolic dysfunction, in terms of the reduced maximal velocity of pressure incline and the slope of end-systolic pressure volume relationship in SHR. In histological analysis, empagliflozin significantly attenuated cardiac fibrosis in both atrial and ventricular tissues. The upregulation of atrial and ventricular expression of PPARα, ACADM, natriuretic peptides (NPPA and NPPB), and TNF-α in SHR, was all restored by treatment of empagliflozin. CONCLUSIONS: Empagliflozin improves hemodynamics in our hypertensive heart failure rat model, associated with renal protection, attenuated cardiac fibrosis, and normalization of HF genes. Our results contribute some understanding of the pleiotropic effects of empagliflozin on improving heart function.


Assuntos
Compostos Benzidrílicos/farmacologia , Glucosídeos/farmacologia , Insuficiência Cardíaca/tratamento farmacológico , Hemodinâmica/efeitos dos fármacos , Hipertensão/complicações , Miocárdio/patologia , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Função Ventricular Esquerda/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos , Animais , Função do Átrio Esquerdo/efeitos dos fármacos , Fator Natriurético Atrial/genética , Fator Natriurético Atrial/metabolismo , Dieta Hiperlipídica , Modelos Animais de Doenças , Ácidos Graxos/metabolismo , Fibrose , Regulação da Expressão Gênica , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/fisiopatologia , Hipertensão/fisiopatologia , Masculino , Miocárdio/metabolismo , Peptídeo Natriurético Encefálico/genética , Peptídeo Natriurético Encefálico/metabolismo , Ratos Endogâmicos SHR , Ratos Endogâmicos WKY , Recuperação de Função Fisiológica , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo
16.
Lab Chip ; 19(9): 1676-1685, 2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-30942226

RESUMO

Although cardiovascular diseases such as heart failure (HF) affect 30 million people globally, the early detection of HF has, until recently, been difficult and prone to misdiagnoses. Monitoring the circulatory levels of a relatively new biomarker, the N-terminal prohormone of a B-type natriuretic peptide, could be used for early risk evaluation of HF. Therefore, we developed a pneumatically-driven, automatic integrated microfluidic platform equipped with micromixers, micropumps, and microvalves for the simultaneous detection of NT-proBNP in up to six clinical samples within 25 min by using a novel aptamer-based sandwich assay, and the limit of detection was only 1.53 pg mL-1; given that the chip is 64% more compact than those developed in our prior works and requires only 5 µL of sample input, it may serve as a promising tool for early diagnosis of HF.


Assuntos
Aptâmeros de Nucleotídeos/metabolismo , Técnicas Biossensoriais/instrumentação , Dispositivos Lab-On-A-Chip , Peptídeo Natriurético Encefálico/análise , Fragmentos de Peptídeos/análise , Integração de Sistemas , Aptâmeros de Nucleotídeos/genética , Sequência de Bases , Calibragem , Desenho de Equipamento , Humanos , Limite de Detecção , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Fatores de Tempo
17.
Int J Cardiovasc Imaging ; 35(9): 1549-1555, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30941564

RESUMO

The transient left atrial appendage (LAA) dysfunction after electrical cardioversion (CV), which is called as LAA-stunning, was found to be an important etiology of thrombus formation. The aim of the present study was to investigate the risk factors of LAA-stunning. This study included 134 patients who underwent catheter ablation for non-paroxysmal, non-valvular, and symptomatic atrial fibrillation (AF). Internal-CV was performed, and LAA emptying fraction (LAA-EF) was assessed using LAA-angiogram before and just after CV. LAA-stunning (defined as 10% reduction of LAA-EF after CV) was observed in 45/134 patients (34%). Patients in LAA-stunning group had longer duration of AF prior to CV, higher brain natriuretic peptide (BNP), higher prevalence of patients taking calcium blocker, larger left atrial (LA) diameter, elevated E wave, and larger LA volume than those in non LAA-stunning group. Multivariate analysis showed that longer duration of AF prior to CV (p = 0.015, OR 1.033 for 1 month extend, 95% CI 1.006-1.073) and elevated BNP (p = 0.038, OR 1.041 for each 10 pg/mL increase, 95% CI 1.001-1.009) were associated with LAA-stunning. In addition, all patients were divided into four groups based on the combination between duration of AF prior to CV and BNP; group 1 (low BNP/short-lasting AF), group 2 (high BNP/short-lasting AF), group 3 (low BNP/long-lasting AF), and group 4 (high BNP/long-lasting AF). The rate of LAA-stunning was the highest in the group 4 (55.6%). Elevated BNP and long duration of AF were associated with LAA stunning after electrical cardioversion.


Assuntos
Apêndice Atrial/fisiopatologia , Fibrilação Atrial/terapia , Função do Átrio Esquerdo , Cardioversão Elétrica/efeitos adversos , Miocárdio Atordoado/etiologia , Idoso , Antiarrítmicos/administração & dosagem , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Biomarcadores/sangue , Bloqueadores dos Canais de Cálcio/administração & dosagem , Esquema de Medicação , Ecocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio Atordoado/diagnóstico por imagem , Miocárdio Atordoado/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima
18.
Biomed Res Int ; 2019: 3265847, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31032342

RESUMO

Objective: Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular (CV) disease (CVD). The objective of the study was to compare CV risk profile in female and male RA patients with low disease activity. Materials and Methods: The study group consisted of 70 RA patients with continuous low disease activity and no CVD (54 women, 16 men) and 33 healthy controls of comparable age. The groups were assessed for blood pressure, serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), carotid intima media thickness (cIMT), electrocardiography, ejection fraction (EF), and diastolic dysfunction (DD). Results: Significantly higher burden of atherosclerosis, as revealed by higher cIMT, was found in males [0.93 (0.2) mm] vs females [0.80 (0.2) mm]. The risk of 10-year CVD was significantly higher in men than in women with RA. High/very high risk of fatal CVD was found in 62.5% of male patients. Males were significantly more often current/ex-smokers and had lower HDL-cholesterol and higher atherogenic index. There were no significant differences in NT-proBNP, QTc duration, and parameters of EF and DD. Conclusions: In RA patients with continued low disease activity, a higher burden of atherosclerosis was found in males than in females. The data suggest a significant impact of traditional CV risk factors.


Assuntos
Artrite Reumatoide/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Medição de Risco , Artrite Reumatoide/sangue , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Espessura Intima-Media Carotídea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Fatores de Risco , Caracteres Sexuais , Volume Sistólico/fisiologia
19.
BMJ Case Rep ; 12(4)2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975785

RESUMO

Mesalazine (5-aminosalicylic acid)-based products are a widely used treatment for inflammatory bowel disease in children and adults. Associated myopericarditis is an uncommon but recorded phenomenon related to drug hypersensitivity. Unless recognised, this important complication may culminate in the development of dilated cardiomyopathy and severe heart failure. We report the case of a boy with Crohn's disease who developed myopericarditis 14 days after starting treatment with mesalazine. Discontinuation of the drug rapidly led to normalisation of left ventricular structure and function, and a parallel improvement in the levels of plasma N-terminal pro-B-type natriuretic peptide and other markers of myocardial damage. Clinicians should be aware of this potentially life-threatening adverse effect of mesalazine therapy, which is quickly and fully reversible on cessation of the agent.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Doença de Crohn/tratamento farmacológico , Mesalamina/efeitos adversos , Miocardite/diagnóstico , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Adolescente , Diagnóstico Diferencial , Humanos , Masculino , Miocardite/induzido quimicamente , Miocardite/metabolismo
20.
Pediatr Cardiol ; 40(5): 973-979, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30937503

RESUMO

Through this study, we aimed to assess the ability of routine neonatal screening at time of bronchopulmonary dysplasia (BPD) diagnosis to predict the development of late pulmonary hypertension (PHTN). This is a retrospective longitudinal cohort study of 37 premature infants with BPD assessing the utility of screening serum brain natriuretic peptide (BNP) and echocardiograms performed at the time of BPD diagnosis ('early PHTN') to predict 'late PHTN' at the last follow-up. Screening evaluation demonstrated early PHTN in 9/37 patients. At an average follow-up interval of 52.7 ± 38.7 weeks, 4/9 had late PHTN; one patient without early PHT had late PHT. At initial screening, infants with late PHTN were significantly more likely to have demonstrated elevated BNP values (p = 0.003), and echocardiographic evidence of right atrial dilatation (p = 0.01), right ventricular hypertrophy (p = 0.01), lower right ventricular area change percentage (p = 0.03), and larger main pulmonary artery Z-scores (p = 0.02). Serum BNP and echocardiographic evaluation performed at the time of BPD diagnosis can detect patients at increased risk of late PHTN. Large, prospective studies are necessary to further address this question.


Assuntos
Displasia Broncopulmonar , Ecocardiografia/métodos , Hipertensão Pulmonar , Peptídeo Natriurético Encefálico/sangue , Triagem Neonatal/métodos , Biomarcadores/sangue , Displasia Broncopulmonar/sangue , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Estudos Longitudinais , Masculino , Estudos Prospectivos , Estudos Retrospectivos
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