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1.
Yonsei Med J ; 62(2): 129-136, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33527792

RESUMO

PURPOSE: Acute decompensated heart failure (ADHF) caused by ischemic heart disease is associated with higher mortality and requires immediate diagnosis. Recently, novel methods to diagnose non-ST elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin have been applied. We compared the clinical utility of high-sensitivity troponin I (hS-TnI), delta troponin I, and other traditional methods to diagnose NSTEMI in patients with ADHF. MATERIALS AND METHODS: This retrospective cross-sectional study was conducted to analyze patients with ADHF who underwent hS-TnI evaluation of 0-2-h protocol in our emergency department. Patients were grouped according to a diagnosis of NSTEMI. RESULTS: A total of 524 ADHF [ADHF with NSTEMI, n=109 (20.8%)] patients were enrolled in this analysis. The mean values of hS-TnI (ng/mL) in the ADHF with and without NSTEMI groups were 2.44±5.60 and 0.25±0.91, respectively. Multivariable analysis revealed that regional wall-motion abnormality, T-wave inversion/hyperacute T wave, and initial and delta hS-TnI were predictive factors for NSTEMI. Laboratory values related to cardiac biomarkers, including hS-TnI [odds ratio (OR) (95% confidence interval, CI): 2.18], and the delta hS-TnI [OR (95% CI): 1.55] were significant predictors of NSTEMI. Moreover, receiver operating characteristic analysis showed that the areas under receiver operating characteristic curves for electrocardiographic abnormalities, initial hS-TnI, and delta hS-TnI were 0.794, 0.802, and 0.773, respectively. CONCLUSION: For diagnosis of suspected NSTEMI in patients with ADHF, initial hS-TnI assay has similar predictive value as ischemic changes on electrocardiogram and superior predictive value than delta hS-TnI calculated by the 0-2-h protocol.


Assuntos
Bioensaio , Insuficiência Cardíaca/complicações , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Troponina I/metabolismo , Idoso , Biomarcadores , Estudos Transversais , Diagnóstico Diferencial , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Infarto do Miocárdio/diagnóstico por imagem , Peptídeo Natriurético Encefálico/metabolismo , Curva ROC , Estudos Retrospectivos
2.
Biomed Res Int ; 2021: 9491615, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33521132

RESUMO

Background: L-carnitine mediates the utilization of fatty acids and glucose in the myocardium. The potential of L-carnitine in managing dilated cardiomyopathy (DCM) in patients has been extensively reported, with additional benefits. Objective: This meta-analysis purposed to explore the clinical efficacy of L-carnitine therapy on DCM patients. Methods: We searched publications up to May 2020 from several databases including PubMed, Embase, Cochrane Library, Chinese Biomedical (CBM) database, Chinese Science and Technology Periodicals database (VIP), Chinese National Knowledge Infrastructure (CNKI) database, and Wanfang database. Subsequently, publications that met the inclusion criteria were systematically evaluated by two independent reviewers. Results: A total of 23 RCTs conducted in China with 1455 DCM patients were included in this study. In the meta-analysis, L-carnitine therapy was associated with a considerable improvement in the overall efficacy (RR = 1.28, 95% CI (1.21-1.36), P < 0.0001), left ventricular ejection fraction (LVEF) (MD = 6.16%, 95% CI (4.50, 7.83), P < 0.0001), and cardiac output (CO) (MD = 0.88 L/min, 95% CI (0.51, 1.25), P < 0.0001) as compared to the control group. Moreover, L-carnitine therapy significantly decreased left ventricular end-diastolic dimension (LVEDD) (MD = -2.53, 95% CI (-3.95, -1.12), P = 0.0005), brain natriuretic peptide (BNP) (SMD = -1.71 ng/L, 95% CI (-3.02, -0.40), P = 0.01), and the transforming growth factor-beta (TGF-ß1) (MD = -56.78 ng/L, 95% CI (-66.02, -47.53), P < 0.0001). Conclusions: L-carnitine potentially enhanced the therapeutic efficiency in DCM patients. Following weaknesses in the evidence due to low methodological quality and high clinical heterogeneity in the included studies, well-designed trials are recommended.


Assuntos
Cardiomiopatia Dilatada/tratamento farmacológico , Carnitina/uso terapêutico , Ácidos Graxos/metabolismo , Glucose/metabolismo , Miocárdio/metabolismo , Humanos , Peptídeo Natriurético Encefálico/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Risco , Volume Sistólico , Fator de Crescimento Transformador beta1/metabolismo , Função Ventricular Esquerda
3.
Am J Emerg Med ; 42: 83-89, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33493833

RESUMO

BACKGROUND: Degradation of the endothelial glycocalyx is recognized as a major part of the pathophysiology of sepsis. Previous clinical studies, mostly conducted in intensive care settings, showed associations between glycocalyx shedding and clinical outcomes. We aimed to explore the association of plasma syndecan-1, a marker of glycocalyx degradation, with the subsequent fluid requirements and clinical outcomes of emergency department patients with sepsis. METHODS: This was a post hoc analysis of a randomized trial of fluid resuscitation in the emergency department. The study was conducted in the emergency department of an urban 1500-bed tertiary care center. The data of 95 adults who were diagnosed with sepsis-induced hypoperfusion and had undergone baseline syndecan-1 measurement were included. The syndecan-1 levels at baseline (T0) and hour 6 (T6) were studied to characterize their association with clinical outcomes, including subsequent fluid administration, organ failure outcomes and mortality. RESULTS: The median syndecan-1 levels at T0 and T6 were 207 (IQR 135-438) and 207 (IQR 128-490) ng/ml, respectively. Syndecan-1 levels at T0 were correlated with baseline sequential organ failure assessment (SOFA) score (ρ = 0.35, p < 0.001). Syndecan-1 levels at both T0 and T6 were correlated with subsequent fluid administration over 24 and 72 h and associated with the diagnosis of septic shock, the maximum dose of vasopressors and the need for renal replacement therapy (p < 0.05). Higher syndecan-1 levels at T6 were associated with higher 90-day mortality (p = 0.03). CONCLUSIONS: In the emergency department, syndecan-1 levels were associated with fluid requirements, sepsis severity, organ dysfunction, and mortality.


Assuntos
Serviço Hospitalar de Emergência , Hidratação , Glicocálix/metabolismo , Sepse/metabolismo , Sepse/terapia , Sindecana-1/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Endotélio/metabolismo , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Peptídeo Natriurético Encefálico/metabolismo , Escores de Disfunção Orgânica , Fragmentos de Peptídeos/metabolismo , Sepse/mortalidade , Resultado do Tratamento
4.
Med Hypotheses ; 147: 110486, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33460992

RESUMO

On March 11, 2020 the World Health Organization (WHO) declared the state of global pandemic caused by the new SARS-CoV-2 (COVID-19). To date, no antivirals directed against SARS-CoV-2 or effective vaccines to combat the viral infection are available. Severe acute respiratory syndrome caused by SARS-CoV-2 is treated empirically with antivirals, anti-inflammatory, anticoagulants. The approval of an effective vaccine still takes time. In this state, it may be useful to find new therapeutic solutions from drugs already on the market. Recent hypotheses suggest that the use of AT-1 receptor antagonists (ARB) in combination with neprilisin inhibitors (NEPi) could indirectly provide clinical benefits to patients with SARS-CoV-2 and cardiac involvement. In this article we investigate and describe a possible innovative pharmacological approach for the treatment of the most severe stages of COVID-19 infection.


Assuntos
Aminobutiratos/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Tetrazóis/administração & dosagem , Valsartana/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina , Antivirais/uso terapêutico , Síndrome da Liberação de Citocina/virologia , Citocinas/metabolismo , Combinação de Medicamentos , Insuficiência Cardíaca/virologia , Homeostase , Humanos , Inflamação , Modelos Teóricos , Peptídeo Natriurético Encefálico/metabolismo , Neprilisina/efeitos adversos , Fragmentos de Peptídeos/metabolismo , Receptor Tipo 2 de Angiotensina/metabolismo , Organização Mundial da Saúde
5.
Clin Drug Investig ; 41(2): 169-176, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33484468

RESUMO

PURPOSE: Patients affected by heart failure with reduced ejection fraction (HFrEF) receive clinical and functional beneficial effects from treatment with sacubitril/valsartan. However previous studies have shown that patients with an implantable cardioverter defibrillator (ICD) could obtain even greater benefit, but only make up a only a small proportion of patients. In the current study we evaluated the effect of sacubitril/valsartan in patients with an ICD. METHODS: Thirty-five outpatients with HFrEF (aged 60 ± 11 years, 28 were males), on optimal medical therapy were studied. All patients received an ICD at least 6 months before enrollment or were non-responders to ICD plus resynchronization (CRT-D). An open-label sacubitril/valsartan treatment was established at the maximum tolerated dose. Clinical assessment, 6-min walk test (6MWT) and echocardiography, were performed during follow-up at 90, 180, and 360 days. Quality of life score and perceived fatigue on exercise were assessed. RESULTS: Clinical conditions dramatically improved in most patients, especially within the first 6 months of therapy (76 % were in NYHA-I and 24 % in NYHA-II at the end of study vs 71 % NYHA-II and 29 % NYHA III at enrollment, p < 0.001). Quality of life and exercise performance significantly improved according to N-terminal pro-brain natriuretic peptide (NT-proBNP) serum levels lowering. Walking distance at 6MWT increased from 274 ± 97 to 389 ± 53 m and walking speed from 0.74 ± 0.27 to 1.07 ± 0.15 m/s (p < 0.001), while oxygen saturation did not differ significantly (from 90 ± 1 % to 91 ± 2 %). More gradual was left ventricular reverse remodeling. Ejection fraction improved mildly (+ 5 points %, p < 0.001). Global longitudinal strain and diastolic function were also assessed over time. CONCLUSION: Sacubitril/valsartan therapy for HFrEF may lead to significant clinical and functional improvements even in patients with ICD at greater arrhythmic risk. Clinical improvement is obtained within the first 6 months of treatment while reverse remodeling needs more time.


Assuntos
Aminobutiratos/administração & dosagem , Desfibriladores Implantáveis , Insuficiência Cardíaca/tratamento farmacológico , Tetrazóis/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Combinação de Medicamentos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/metabolismo , Pacientes Ambulatoriais , Fragmentos de Peptídeos/metabolismo , Qualidade de Vida , Volume Sistólico/efeitos dos fármacos , Resultado do Tratamento
7.
Cardiol Rev ; 29(1): 39-42, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33136582

RESUMO

Patients older than 65 years hospitalized with COVID-19 have higher rates of intensive care unit admission and death when compared with younger patients. Cardiovascular conditions associated with COVID-19 include myocardial injury, acute myocarditis, cardiac arrhythmias, cardiomyopathies, cardiogenic shock, thromboembolic disease, and cardiac arrest. Few studies have described the clinical course of those at the upper extreme of age. We characterize the clinical course and outcomes of 73 patients with 80 years of age or older hospitalized at an academic center between March 15 and May 13, 2020. These patients had multiple comorbidities and often presented with atypical clinical findings such as altered sensorium, generalized weakness and falls. Cardiovascular manifestations observed at the time of presentation included new arrhythmia in 7/73 (10%), stroke/intracranial hemorrhage in 5/73 (7%), and elevated troponin in 27/58 (47%). During hospitalization, 38% of all patients required intensive care, 13% developed a need for renal replacement therapy, and 32% required vasopressor support. All-cause mortality was 47% and was highest in patients who were ever in intensive care (71%), required mechanical ventilation (83%), or vasopressors (91%), or developed a need for renal replacement therapy (100%). Patients older than 80 years old with COVID-19 have multiple unique risk factors which can be associated with increased cardiovascular involvement and death.


Assuntos
Lesão Renal Aguda/terapia , Mortalidade Hospitalar , Terapia de Substituição Renal/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Vasoconstritores/uso terapêutico , Centros Médicos Acadêmicos , Acidentes por Quedas , Lesão Renal Aguda/etiologia , Idoso de 80 Anos ou mais , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Aspartato Aminotransferases/metabolismo , Proteína C-Reativa/metabolismo , /metabolismo , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/fisiopatologia , Causas de Morte , Transtornos da Consciência/fisiopatologia , Dispneia/fisiopatologia , Feminino , Ferritinas/metabolismo , Febre/fisiopatologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hospitalização , Humanos , Hipóxia/fisiopatologia , Hipóxia/terapia , Vida Independente , Unidades de Terapia Intensiva/estatística & dados numéricos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/fisiopatologia , Contagem de Leucócitos , Hepatopatias/etiologia , Hepatopatias/metabolismo , Contagem de Linfócitos , Masculino , Debilidade Muscular/fisiopatologia , Peptídeo Natriurético Encefálico/metabolismo , Casas de Saúde , Oxigenoterapia , Pró-Calcitonina/metabolismo , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Troponina I/metabolismo
8.
Int J Mol Sci ; 22(1)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33375031

RESUMO

Dysregulated inflammasome activation and interleukin (IL)-1ß production are associated with several inflammatory disorders. Three different routes can lead to inflammasome activation: a canonical two-step, a non-canonical Caspase-4/5- and Gasdermin D-dependent, and an alternative Caspase-8-mediated pathway. Natriuretic Peptides (NPs), Atrial Natriuretic Peptide (ANP) and B-type Natriuretic Peptide (BNP), binding to Natriuretic Peptide Receptor-1 (NPR-1), signal by increasing cGMP (cyclic guanosine monophosphate) levels that, in turn, stimulate cGMP-dependent protein kinase-I (PKG-I). We previously demonstrated that, by counteracting inflammasome activation, NPs inhibit IL-1ß secretion. Here we aimed to decipher the molecular mechanism underlying NPs effects on THP-1 cells stimulated with lipopolysaccharide (LPS) + ATP. Involvement of cGMP and PKG-I were assessed pre-treating THP-1 cells with the membrane-permeable analogue, 8-Br-cGMP, and the specific inhibitor KT-5823, respectively. We found that NPs, by activating NPR-1/cGMP/PKG-I axis, lead to phosphorylation of NLRP3 at Ser295 and to inflammasome platform disassembly. Moreover, by increasing intracellular cGMP levels and activating phosphodiesterases, NPs interfere with both Gasdermin D and Caspase-8 cleavage, indicating that they disturb non-canonical and alternative routes of inflammasome activation. These results showed that ANP and BNP anti-inflammatory and immunomodulatory actions may involve the inhibition of all the known routes of inflammasome activation. Thus, NPs might be proposed for the treatment of the plethora of diseases caused by a dysregulated inflammasome activation.


Assuntos
Fator Natriurético Atrial/metabolismo , GMP Cíclico/metabolismo , Inflamassomos/metabolismo , Peptídeo Natriurético Encefálico/metabolismo , Receptores do Fator Natriurético Atrial/metabolismo , Trifosfato de Adenosina/farmacologia , Caspase 8/metabolismo , Proteína Quinase Dependente de GMP Cíclico Tipo I/metabolismo , Humanos , Inflamassomos/efeitos dos fármacos , Interleucina-1beta/metabolismo , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Lipopolissacarídeos/farmacologia , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Proteínas de Ligação a Fosfato/metabolismo , Transdução de Sinais/efeitos dos fármacos , Células THP-1
9.
J Korean Med Sci ; 35(39): e349, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33045772

RESUMO

BACKGROUNDS: The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has spread worldwide. Cardiac injury after SARS-CoV-2 infection is a major concern. The present study investigated impact of the biomarkers indicating cardiac injury in coronavirus disease 2019 (COVID-19) on patients' outcomes. METHODS: This study enrolled patients who were confirmed to have COVID-19 and admitted at a tertiary university referral hospital between February 19, 2020 and March 15, 2020. Cardiac injury was defined as an abnormality in one of the following result markers: 1) myocardial damage marker (creatine kinase-MB or troponin-I), 2) heart failure marker (N-terminal-pro B-type natriuretic peptide), and 3) electrical abnormality marker (electrocardiography). The relationship between each cardiac injury marker and mortality was evaluated. Survival analysis of mortality according to the scoring by numbers of cardiac injury markers was also performed. RESULTS: A total of 38 patients with COVID-19 were enrolled. Twenty-two patients (57.9%) had at least one of cardiac injury markers. The patients with cardiac injuries were older (69.6 ± 14.9 vs. 58.6 ± 13.9 years old, P = 0.026), and were more male (59.1% vs. 18.8%, P = 0.013). They showed lower initial oxygen saturation (92.8 vs. 97.1%, P = 0.002) and a trend toward higher mortality (27.3 vs. 6.3%, P = 0.099). The increased number of cardiac injury markers was significantly related to a higher incidence of in-hospital mortality which was also evidenced by Kaplan-Meier survival analysis (P = 0.008). CONCLUSION: The increased number of cardiac injury markers is related to in-hospital mortality in patients with COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Miocárdio/metabolismo , Pneumonia Viral/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Creatina Quinase Forma MB/metabolismo , Eletrocardiografia , Feminino , Traumatismos Cardíacos/metabolismo , Traumatismos Cardíacos/patologia , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Peptídeo Natriurético Encefálico/metabolismo , Pandemias , Fragmentos de Peptídeos/metabolismo , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Fatores Sexuais , Centros de Atenção Terciária , Troponina I/metabolismo
10.
Life Sci ; 260: 118408, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32926931

RESUMO

AIMS: Baseline elevated B-type Natriuretic Peptide (BNP) has been found in high altitude pulmonary edema susceptible population. Exaggerated pulmonary vascular response to hypoxia may be related to endothelial dysfunction in hypoxia susceptible. We hypothesize that baseline BNP levels can predict hypoxia susceptibility in healthy individuals. MAIN METHODS: The pulmonary vascular response to hypoxia was compared in 35 male healthy individuals divided into two groups based on BNP levels (Group 1 ≤ 15 and Group 2 > 15 pg/ml). Acute normobaric hypoxia was administered to both the groups, to confirm hypoxia susceptibility in Group 2. KEY FINDINGS: Unlike Group 1, Group 2 had elevated post hypoxia BNP levels (26 vs 33.5 pg/ml, p = 0.002) while pulmonary artery pressure was comparable. A negative correlation with tissue oxygen consumption (delta pO2) and compartmental fluid shift was seen in Group 1 only. Endothelial dysfunction in Group 2 resulted in reduced vascular compliance leading to elevation of mean blood pressure on acute hypoxia exposure. BNP showed a positive correlation with endothelial dysfunction in Group 2 and has been linked to pre-diabetic disorder (HbA1c 6 ± 0.44%) and may additionally represent a lower cross-sectional area of vascular bed related to vascular remodeling mediated by chronic hypoxia. SIGNIFICANCE: Hypoxia susceptibility in healthy individuals may be related to endothelial dysfunction that limits vascular compliance during hypoxic stress. BNP level showed positive correlation with HbA1c (r = 0.49, p = 0.04) and negative correlation with delta pO2 (r = -0.52, p = 0.04) can predict reduced microvascular compliance due to endothelial dysfunction contributing to hypoxia susceptibility in healthy individuals. BNP levels≤15 pg/ml at sea level is indicative of hypoxia resistance.


Assuntos
Altitude , Endotélio Vascular/fisiopatologia , Hipóxia/fisiopatologia , Pulmão/fisiopatologia , Peptídeo Natriurético Encefálico/metabolismo , Artéria Pulmonar/fisiopatologia , Edema Pulmonar/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Testes de Função Respiratória
11.
JACC Heart Fail ; 8(10): 789-799, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32641226

RESUMO

The PARADIGM-HF (Prospective Comparison of Angiotensin II Receptor Blocker Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial reported that sacubitril/valsartan (S/V), an angiotensin receptor-neprilysin inhibitor, significantly reduced mortality and heart failure (HF) hospitalization in HF patients with a reduced ejection fraction (HFrEF). However, fewer than 1% of patients in the PARADIGM-HF study had New York Heart Association (NYHA) functional class IV symptoms. Accordingly, data that informed the use of S/V among patients with advanced HF were limited. The LIFE (LCZ696 in Hospitalized Advanced Heart Failure) study was a 24-week prospective, multicenter, double-blinded, double-dummy, active comparator trial that compared the safety, efficacy, and tolerability of S/V with those of valsartan in patients with advanced HFrEF. The trial planned to randomize 400 patients ≥18 years of age with advanced HF, defined as an EF ≤35%, New York Heart Association functional class IV symptoms, elevated natriuretic peptide concentration (B-type natriuretic peptide [BNP] ≥250 pg/ml or N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥800 pg/ml), and ≥1 objective finding of advanced HF. Following a 3- to 7-day open label run-in period with S/V (24 mg/26 mg twice daily), patients were randomized 1:1 to S/V titrated to 97 mg/103 mg twice daily versus 160 mg of V twice daily. The primary endpoint was the proportional change from baseline in the area under the curve for NT-proBNP levels measured through week 24. Secondary and tertiary endpoints included clinical outcomes and safety and tolerability. Because of the COVID-19 pandemic, enrollment in the LIFE trial was stopped prematurely to ensure patient safety and data integrity. The primary analysis consists of the first 335 randomized patients whose clinical follow-up examination results were not severely impacted by COVID-19. (Entresto [LCZ696] in Advanced Heart Failure [LIFE STUDY] [HFN-LIFE]; NCT02816736).


Assuntos
Aminobutiratos/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Tetrazóis/uso terapêutico , Betacoronavirus , Cardiotônicos/uso terapêutico , Infecções por Coronavirus , Relação Dose-Resposta a Droga , Método Duplo-Cego , Combinação de Medicamentos , Término Precoce de Ensaios Clínicos , Taxa de Filtração Glomerular , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração , Coração Auxiliar , Hospitalização/estatística & dados numéricos , Humanos , Hipotensão/induzido quimicamente , Peptídeo Natriurético Encefálico/metabolismo , Pandemias , Fragmentos de Peptídeos/metabolismo , Pneumonia Viral , Volume Sistólico
12.
PLoS One ; 15(7): e0235570, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614895

RESUMO

BACKGROUND: The association among psychological, neuropsychological dysfunctions and functional/clinical variables in Chronic Heart Failure (CHF) has been extensively addressed in literature. However, only a few studies investigated those associations in the older population. PURPOSE: To evaluate the psychological/neuropsychological profile of older CHF patients, to explore the interrelation with clinical/functional variables and to identify potential independent predictors of patients' functional status. METHODS: This study was conducted with a multi-center observational design. The following assessments were performed: anxiety (Hospital Anxiety and Depression Scale, HADS), depression (Geriatric Depression Scale, GDS), cognitive impairment (Addenbrooke's Cognitive Examination Revised, ACE-R), executive functions (Frontal Assessment Battery, FAB), constructive abilities (Clock Drawing Test, CDT), psychomotor speed and alternated attention (Trail Making Test, TMT-A/B), functional status (6-minute walking test, 6MWT) and clinical variables (New York Heart Association, NYHA; Brain Natriuretic Peptide, BNP; left ventricular ejection fraction, LVEF; left ventricular end diastolic diameter, LVEDD; left ventricular end diastolic volume, LVEDV; tricuspid annular plane systolic excursion, TAPSE). RESULTS: 100 CHF patients (mean age: 74.9±7.1 years; mean LVEF: 36.1±13.4) were included in the study. Anxious and depressive symptoms were observed in 16% and 24,5% of patients, respectively. Age was related to TMT-A and CDT (r = 0.49, p<0.001 and r = -0.32, p = 0.001, respectively), Log-BNP was related to ACE-R-Fluency subtest, (r = -0.22, p = 0.034), and 6MWT was related to ACE-R-Memory subtest and TMT-A (r = 0.24, p = 0.031 and r = -0.32, p = 0.005, respectively). Both anxiety and depression symptoms were related to ACE-R-Total score (r = -0.25, p = 0.013 and r = -0.32, p = 0.002, respectively) and depressive symptoms were related to CDT (r = -0.23, p = 0.024). At multiple regression analysis, Log-BNP and TMT-A were significant and independent predictors of functional status: worse findings on Log-BNP and TMT-A were associated with shorter distance walked at the 6MWT. CONCLUSIONS: Psychological and neuropsychological screening, along with the assessment of psychomotor speed (TMT-A), may provide useful information for older CHF patients undergoing cardiac rehabilitation.


Assuntos
Reabilitação Cardíaca , Insuficiência Cardíaca/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Doença Crônica , Estudos Transversais , Transtorno Depressivo/etiologia , Emoções , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Peptídeo Natriurético Encefálico/metabolismo , Análise de Regressão , Volume Sistólico/fisiologia , Teste de Sequência Alfanumérica , Função Ventricular Esquerda/fisiologia , Teste de Caminhada
13.
Dtsch Med Wochenschr ; 145(11): 755-760, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32492745

RESUMO

Current pandemic caused by SARS-CoV-2 inducing viral COVID-19 pneumonia, is categorized in 3 stages. Some biomarkers could be assigned to one of these stages, showing a correlation to mortality in COVID-19 patients. Laboratory findings in COVID-19, especially when serially evaluated, may represent individual disease severity and prognosis. These may help planning and controlling therapeutic interventions. Biomarkers for myocardial injury (high sensitive cardiac troponin, hsTn) or hemodynamic stress (NTproBNP) may occur in COVID-19 pneumonia such as in other pneumonias, correlating with severity and prognosis of the underlying disease. In hospitalized COVID-19 patients' mild increases of hsTn or NTproBNP may be explained by cardiovascular comorbidities and direct or indirect cardiac damage or stress caused by or during COVID-19 pneumonia. In case of suspected NSTE-ACS and COVID-19, indications for echocardiography or reperfusion strategy should be carefully considered against the risk of contamination.


Assuntos
Cardiomiopatias/virologia , Infecções por Coronavirus/complicações , Pandemias/classificação , Pneumonia Viral/classificação , Adulto , Biomarcadores , Cardiomiopatias/epidemiologia , Cardiomiopatias/patologia , Comorbidade , Infecções por Coronavirus/classificação , Infecções por Coronavirus/genética , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Humanos , Masculino , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Fenótipo , Pneumonia Viral/genética , Risco , Troponina C/metabolismo
14.
PLoS One ; 15(6): e0235493, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32589688

RESUMO

AIMS: The prognostic impact of worsening renal function (WRF) in patients with acute heart failure (AHF) remains under debate. Successful decongestion might offset the negative impact of WRF, but little is known about indicators of successful decongestion in the very acute phase of AHF. We hypothesized that decongestion as evaluated by the percent reduction in brain natriuretic peptide (BNP) could identify relevant prognostic implications of WRF in the very acute phase of AHF. METHODS AND RESULTS: Data on 907 consecutive hospitalized patients with AHF in the REALITY-AHF study (age: 78±12 years; 55.1% male) were analyzed. Creatinine and BNP were measured at baseline and 48 hours from admission. WRF was defined as an increase in creatinine >0.3 mg at 48 hours from admission. The primary endpoint was 1-year all-cause mortality. Patients were divided into four groups according to the presence/absence of WRF and a BNP reduction higher/lower than the median: no-WRF/higher-BNP-reduction (n = 390), no-WRF/lower-BNP-reduction (n = 397), WRF/higher-BNP-reduction (n = 63), and WRF/lower-BNP-reduction groups (n = 57). Kaplan-Meier curve analysis showed that the WRF/lower-BNP-reduction group had a worse prognosis than the other groups. In a Cox regression analysis, only the WRF/lower-BNP-reduction group had higher mortality compared to the no-WRF/higher-BNP-reduction group (hazard ratio: 3.34, p<0.001). CONCLUSION: In the very acute phase of AHF, BNP reduction may aid in identifying relevant prognostic significance of WRF.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Rim/fisiopatologia , Peptídeo Natriurético Encefálico/metabolismo , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/metabolismo , Humanos , Masculino , Prognóstico
15.
PLoS One ; 15(6): e0234294, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32542005

RESUMO

BACKGROUND: Although global longitudinal strain (GLS) measurements provide useful predictive information, measurement variability is still a major concern. We sought to determine whether fully automated GLS measurements could predict future cardiac events in patients with known or suspected heart failure (HF). METHODS: GLS was measured using fully automated 2D speckle tracking analysis software (AutoStrain, TomTec) in 3,150 subjects who had undergone clinically indicated brain natriuretic peptide (BNP) assays and echocardiographic examinations. Among 1,514 patients in the derivation cohort, optimal cut-off values of BNP and GLS for cardiac death (CD) and major adverse cardiovascular events (MACEs) were determined using survival classification and regression tree (CART) analysis. The remaining 1,636 patients, comprising the validation cohort, were stratified into subgroups according to predefined cut-off values, and survival curves were compared. RESULTS: Survival CART analysis selected GLS with cut-off values of 6.2% and 14.0% for predicting CD. GLS of 6.9% and 13.9% and BNP of 83.2 pg/mL and 206.3 pg/mL were selected for predicting MACEs. For simplicity, we defined GLS of 7% and 14% and BNP of 100 pg/mL and 200 pg/mL as cut-off values. These cut-off values stratify high-risk patients in the validation cohort with known or suspected HF for both CD and MACEs. CONCLUSIONS: In addition to BNP, fully automated GLS measurements provide prognostic information for patients with known or suspected HF, and this approach facilitates clinical work flow.


Assuntos
Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/metabolismo , Peptídeo Natriurético Encefálico/metabolismo , Idoso , Automação , Estudos de Coortes , Ecocardiografia , Feminino , Humanos , Estudos Longitudinais , Masculino , Prognóstico , Estudos Retrospectivos
16.
BMC Neurol ; 20(1): 227, 2020 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-32498673

RESUMO

BACKGROUND: We present a case with a close temporal association of the first diagnosis of multiple sclerosis and stress cardiomyopathy. CASE PRESENTATION: A 19-year-old man experienced severe dyspnoea. The cardiac biomarkers troponin T and NT-proBNP were elevated, and transthoracic echocardiography showed basal hypokinesia. The man was diagnosed with stress cardiomyopathy after main differential diagnoses such as acute coronary syndrome, myocarditis, and pheochromocytoma were excluded. Furthermore, the patient reported vertigo and paraesthesia. Brain and spinal MRI revealed T2-hyperintense lesions with a prominent acute lesion in the pontomedullary area. Cerebrospinal fluid findings revealed a lymphocytic pleocytosis and intrathecal IgG synthesis. Serum neurofilaments were elevated. The patient was diagnosed with MS, and treatment with intravenous Methylprednisolone was initiated. The brainstem lesion due to multiple sclerosis was assumed to be the cause of stress cardiomyopathy. The patient fully recovered. CONCLUSION: Stress cardiomyopathy may be linked with the first manifestation of multiple sclerosis in the presented case since pontomedullary lesions could affect the sympathetic nervous system. This case highlights the importance of neurological history and examination in young patients with unexplained acute cardiac complaints.


Assuntos
Ecocardiografia , Esclerose Múltipla/complicações , Cardiomiopatia de Takotsubo/etiologia , Biomarcadores/metabolismo , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Troponina T/metabolismo , Adulto Jovem
17.
Travel Med Infect Dis ; 36: 101782, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32526372

RESUMO

INTRODUCTION: There are currently no satisfactory methods for predicting the outcome of Coronavirus Disease-2019 (COVID-19). The aim of this study is to establish a model for predicting the prognosis of the disease. METHODS: The laboratory results were collected from 54 deceased COVID-19 patients on admission and before death. Another 54 recovered COVID-19 patients were enrolled as control cases. RESULTS: Many laboratory indicators, such as neutrophils, AST, γ-GT, ALP, LDH, NT-proBNP, Hs-cTnT, PT, APTT, D-dimer, IL-2R, IL-6, IL-8, IL-10, TNF-α, CRP, ferritin and procalcitonin, were all significantly increased in deceased patients compared with recovered patients on admission. In contrast, other indicators such as lymphocytes, platelets, total protein and albumin were significantly decreased in deceased patients on admission. Some indicators such as neutrophils and procalcitonin, others such as lymphocytes and platelets, continuously increased or decreased from admission to death in deceased patients respectively. Using these indicators alone had moderate performance in differentiating between recovered and deceased COVID-19 patients. A model based on combination of four indicators (P = 1/[1 + e-(-2.658+0.587×neutrophils - 2.087×lymphocytes - 0.01×platelets+0.004×IL-2R)]) showed good performance in predicting the death of COVID-19 patients. When cutoff value of 0.572 was used, the sensitivity and specificity of the prediction model were 90.74% and 94.44%, respectively. CONCLUSIONS: Using the current indicators alone is of modest value in differentiating between recovered and deceased COVID-19 patients. A prediction model based on combination of neutrophils, lymphocytes, platelets and IL-2R shows good performance in predicting the outcome of COVID-19.


Assuntos
Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Fosfatase Alcalina/metabolismo , Aspartato Aminotransferases/metabolismo , Betacoronavirus , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Infecções por Coronavirus/sangue , Infecções por Coronavirus/metabolismo , Feminino , Ferritinas/metabolismo , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Interleucina-10/metabolismo , Interleucina-6/metabolismo , Interleucina-8/metabolismo , L-Lactato Desidrogenase/metabolismo , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Peptídeo Natriurético Encefálico/metabolismo , Neutrófilos , Pandemias , Tempo de Tromboplastina Parcial , Fragmentos de Peptídeos/metabolismo , Pneumonia Viral/sangue , Pneumonia Viral/metabolismo , Pró-Calcitonina/metabolismo , Prognóstico , Tempo de Protrombina , Curva ROC , Receptores de Interleucina-2/metabolismo , Troponina T/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , gama-Glutamiltransferase/metabolismo
18.
Cardiovasc Drugs Ther ; 34(4): 463-473, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32394178

RESUMO

PURPOSE: Berberine was reported to exert beneficial effects on cardiac hypertrophy. However, its cellular and molecular mechanisms still remained unclear. METHODS: Cardiac hypertrophy was induced in male Sprague-Dawley (SD) rats by transverse aorta constriction (TAC), with or without 6-week treatment of berberine. Echocardiography was performed to evaluate cardiac function. Rats were then sacrificed for histological assay, with detection for proteins and mRNA. H9c2 cells were pretreated with berberine of different concentrations (0, 1 µM, and 10 µM), followed by treatment with 2 µM norepinephrine (NE). Cells of different groups were measured for cell surface area, with mRNA detected by qRT-PCR and proteins by western blot. RESULTS: Compared with the sham group, rats of the TAC group showed significantly increased cardiac hypertrophy and fibrosis, which could be ameliorated by treatment with berberine. Western blot showed that mammalian target of rapamycin (mTOR) signaling-related protein expressions, including phospho-mTOR, phospho-4EBP1, and phospho-p70 S6K (Thr389), but not phospho-p70 S6K (Ser371), were significantly increased in the TAC group, which were inhibited by berberine treatment. H9c2 cells were treated with NE to induce hypertrophy with increased cell surface area and mRNA expressions of anp and bnp. Berberine of 10 µM, but not 1 µM, significantly ameliorated NE-induced hypertrophy and inhibited protein expressions of mTOR signaling pathway similar to those in the rat model. CONCLUSIONS: Berberine can exert cardioprotective effects on both pressure-overloaded cardiac hypertrophy and failure in vivo and NE-induced hypertrophy in vitro. Our results suggest berberine could be a potential treatment for patients with cardiac hypertrophy and failure.


Assuntos
Berberina/farmacologia , Hipertrofia Ventricular Esquerda/prevenção & controle , Miócitos Cardíacos/efeitos dos fármacos , Inibidores de Proteínas Quinases/farmacologia , Serina-Treonina Quinases TOR/antagonistas & inibidores , Função Ventricular Esquerda/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos , Animais , Fator Natriurético Atrial/metabolismo , Linhagem Celular , Modelos Animais de Doenças , Fibrose , Hipertrofia Ventricular Esquerda/enzimologia , Hipertrofia Ventricular Esquerda/patologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Masculino , Miócitos Cardíacos/enzimologia , Miócitos Cardíacos/patologia , Peptídeo Natriurético Encefálico/metabolismo , Fosforilação , Ratos Sprague-Dawley , Proteínas Quinases S6 Ribossômicas 70-kDa/metabolismo , Transdução de Sinais , Serina-Treonina Quinases TOR/metabolismo
19.
Am J Kidney Dis ; 76(2): 233-247, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32387090

RESUMO

RATIONALE & OBJECTIVE: Use of brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) for cardiovascular (CV) risk assessment in patients with end-stage kidney disease (ESKD) remains unclear. We examined the associations between different threshold elevations of these peptide levels and clinical outcomes in patients with ESKD. STUDY DESIGN: Systematic review and meta-analysis. SETTING & STUDY POPULATIONS: We searched MEDLINE and EMBASE (through September 2019) for observational studies of adults with ESKD (estimated glomerular filtration rate≤15mL/min/1.73m2 or receiving maintenance dialysis). SELECTION CRITERIA FOR STUDIES: Studies that reported NT-proBNP or BNP levels and future CV events, CV mortality, or all-cause mortality. DATA EXTRACTION: Cohort characteristics and measures of risk associated with study-specified peptide thresholds. ANALYTICAL APPROACH: Hazard ratios (HRs) for clinical outcomes associated with different NT-proBNP and BNP ranges were categorized into common thresholds and pooled using random-effects meta-analysis. RESULTS: We identified 61 studies for inclusion in our review (19,688 people). 49 provided sufficient detail for inclusion in meta-analysis. Pooled unadjusted HRs for CV mortality were progressively greater for greater thresholds of NT-proBNP, from 1.45 (95% CI, 0.91-2.32) for levels>2,000pg/mL to 5.95 (95% CI, 4.23-8.37) for levels>15,000pg/mL. Risk for all-cause mortality was significantly higher at all NT-proBNP thresholds ranging from> 1,000 to> 20,000pg/mL (HR range, 1.53-4.00). BNP levels>550pg/mL were associated with increased risk for CV mortality (HR, 2.54; 95% CI, 1.49-4.33), while the risks for all-cause mortality were 2.04 (95% CI, 0.82-5.12) at BNP levels>100pg/mL and 2.97 (95% CI, 2.21-3.98) at BNP levels>550pg/mL. Adjusted analyses demonstrated similarly greater risks for CV and all-cause mortality with greater NT-proBNP concentrations. LIMITATIONS: Incomplete outcome reporting and risk for outcome reporting bias. Estimation of risk for CV events for specific thresholds of both peptides were limited by poor precision. CONCLUSIONS: ESKD-specific NT-proBNP and BNP level thresholds of elevation are associated with increased risk for CV and all-cause mortality. This information may help guide interpretation of NT-proBNP and BNP levels in patients with ESKD.


Assuntos
Doenças Cardiovasculares/metabolismo , Falência Renal Crônica/metabolismo , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Humanos , Mortalidade , Modelos de Riscos Proporcionais , Medição de Risco
20.
Am J Med Sci ; 360(1): 64-71, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32423749

RESUMO

BACKGROUND: The association between uric acid and N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) in patients with unstable angina pectoris (UAP) is unclear. METHODS: We recruited 260 patients with UAP admitted to the first affiliated Hospital of Guangxi Medical University from February 2018 to August 2018. According to the level of uric acid, patients were divided into 4 groups (Q1 = 48.00-305.00 µmol/L; Q2 = 310.00-405.00 µmol/L; Q3 = 408.00-513.00 µmol/L; Q4 = 514.00-4330.00 µmol/L). The differences of NT-proBNP between groups and the relationship with cardiac function were compared. RESULTS: The average age of the 260 patients enrolled was 75.04 years. The NT-proBNP of the 4 groups showed an increasing trend, and there were significant differences between the 4 groups (<0.001). On the other hand, with the increase of cardiac function (New York Heart Association), the levels of NT-proBNP and uric acid also showed an upward trend (all P < 0.05). Pearson correlation analysis showed that there was a positive correlation between uric acid log10 transform and NT-proBNP log10 transform (r = 0.272, P < 0.001). After adjusting the potential confounding factors, elevated uric acid was still significantly related to the increase of NT-proBNP (Q2 versus [vs.] Q1: OR = 469.64, 95%CI -1396.77 to 2336.05; Q3 vs. Q1: OR = 1166.53, 95%CI -726.12 to 3059.18; Q4 vs. Q1: OR = 3204.78, 95%CI 1240.86-5168.70). In subgroup analysis, the relationship between uric acid and NT-proBNP was significant in males, but no difference was observed in females. CONCLUSIONS: In male patients with UAP, elevated uric acid is related to the increase of NT-proBNP, but this phenomenon is not obvious in female patients.


Assuntos
Angina Instável/metabolismo , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Ácido Úrico/metabolismo , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino
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