Purpose
The aim of our study was to evaluate the relationship between the 24-h blood pressure (BP) profile, plasma NT-proBNP levels and left ventricular hypertrophy (LVH) in subjects with primary ...aldosteronism (PA) compared to patients with essential hypertension (EH).
Methods
A total of 385 consecutive patients with PA 187 with aldosterone producing adenoma (APA) and 198 with idiopathic hyperaldosteronism (IHA) and 385 patients with EH were matched based on age, sex, body mass index (BMI), BP values and duration of hypertension. Twenty-four-hour ambulatory BP monitoring (ABPM), plasma levels of NT-proBNP, left ventricular mass index (LVMI), and other clinical medical data were assessed in all patients.
Results
No differences in age, sex, BMI, clinical BP, 24-h mean BP, daytime BP, or duration of hypertension were found between groups. Nighttime systolic BP (130 ± 16 vs. 127 ± 17 mmHg,
p
< 0.05) and diastolic BP (82 ± 10 vs. 79 ± 11 mmHg,
p
< 0.01) were higher in PA patients than in EH patients. In addition, nocturnal BP decline was reduced, while median NT-proBNP (53.7 vs. 33.2 pg/ml,
P
< 0.001) and LVMI (113 ± 25 vs. 102 ± 26 g/m
2
,
P
< 0.001) were higher in PA patients than in EH patients. Moreover, the median NT-proBNP level was higher in APA patients than in IHA patients (68.0 vs. 42.4 pg/ml,
P
< 0.001). In stepwise multivariate regression analysis, LVMI was correlated with NT-proBNP, nighttime systolic BP and sex in PA patients.
Conclusions
Patients with PA show higher nighttime BP and NT-proBNP levels and lower nocturnal BP decline than those with EH. In addition, higher nocturnal systolic BP has been shown to be strongly associated with cardiac damage in PA patients.
Objective: to investigate the impact of therapy with the interleukin-6 receptor inhibitor tocilizumab (TCZ) on the time course of changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) ...levels in patients with rheumatoid arthritis (RA) during a 12-month follow-up period.Subjects and methods. 31 RA patients (26 women and 5 men) with an inadequate response and/or intolerance to disease-modifying antirheumatic drugs (DMARDs) were included. Their median age was 54 45; 61 years; the disease duration – 110 62; 168 months; DAS28 – 6.2 5.1; 7.1; SDAI – 35.0 23.9; 51.0, and CDAI – 30.0 21.0; 42.0. All the patients were seropositive for rheumatoid factor (RF), 84% – for anti-cyclic citrulinated peptide (anti-CCP) antibodies. Extra-articular manifestations were found in 54% of patients. Patients with chronic heart failure were notincluded. The RA patients were found to have a high frequency of traditional risk factors for cardiovascular diseases (CVD): hypertension (75%), dyslipidemia (61%), smoking (17%), overweight (61%), a family history of CVD (36%), and hypodynamia (68%). Coronary heart disease was diagnosed in 11% of patients. The inefficacy of three or more NSAIDs was noted in 45% of cases; intolerance to previous therapy with NSAIDs was observed in 55%. The patients received TCZ at a dose of 8 mg/kg every 4 weeks: 39% received TCZ alone; 61% – in combination with methotrexate (MTX), the MTX median dose was 20 18; 25 mg/week. The level of NT-proBNP was measured before and 12 months after TCZ therapy.Results and discussion. After 12 months of treatment with TCZ 54% of patients had disease remission (DAS28 <2.6), 46% – low disease activity (DAS28 <3.2). Median DAS28 value decreased from 6.2 5.1; 7.1 to 2.7 1.5; 3.3 (p<0.01), erythrocyte sedimentation rate (ESR) – from 38 24; 54 to 8 4; 16 mm/h (p<0.01), C-reactive protein (CRP) – from 27 10; 49 to 0.5 0.2; 0.7 mg/L (p<0.01) and NT-proBNP – from 75.8 43.0; 100.7 to 37.8 25.1; 78.5 pg/l (p=0.01), although the frequency of its increased values (≥100 pg/ml) remained unchanged (13%). There was a correlation of ΔNT-proBNP with ΔESR (r=0.43; p<0.05) and with ΔCRP (r=0.46; p<0.05). No association was found between ΔNT-proBNP, RA activity measures, RF, and anti-CCP. The level of NT-proBNP in patients treated with TCZ alone and in combination with MTX did not differ considerably.Conclusion. After 12 months of treatment to suppress RA activity, there was a decrease in NT-proBNP levels when TCZ was used alone and in combination with MTX. The lower concentration of NT-proBNP was associated with a reduction in acute phase measures (CRP and ESR). Control of RA activity results in the reduced damaging effect of inflammation on the myocardium.
This study was designed to evaluate the impact of septoplasty on cardiopulmonary functions in patients with nasal septal deviation (NSD). A total of 30 consecutive adult patients (mean standard ...deviation age: 33.7 10.9 years, 56.7% were males) who underwent septoplasty due NSD were included. Visual analog scale scores, nose obstruction symptom evaluation scale scores, serum N-terminal Pro BNP levels, and cardiologic examination findings on electrocardiogram, transthoracic echocardiography, and exercise treadmill testing were evaluated both 7 days before and 3-months after septoplasty operation. A significant decrease was noted in mean (standard deviation) visual analog scale scores (8.27 0.83 versus 1.87 0.73, P < 0.001), and nose obstruction symptom evaluation scores (83.7 4.9 versus 12.7 (5.4, P < 0.001) from preoperative to postoperative period, while maximum effort capacity was improved significantly (11.8 1.9 versus 13.1 2.1, P = 0.010) after septoplasty. Echocardiography findings at 3rd postoperative month revealed significant decrease in pulmonary artery systolic pressure (22.2 3.2 versus 19.0 3.6, P = 0.001), whereas significant increase in trans-mitral early diastolic rapid filling (E wave, 0.82 0.14 versus 0.87 0.13, P = 0.011), peak systolic velocity (S, 0.11 0.02 versus 0.12 0.02, P = 0.002), tricuspid annular plane systolic excursion (22.6 3.2 versus 24.9 2.9, P = 0.002), and right ventricle stroke volume (0.14 (0.02 versus 0.15 0.02, P = 0.013). In conclusion, our findings indicate favorable outcome of septoplasty in NSD patients not only in terms of improved nasal airflow but also cardiopulmonary functions, particularly the exercise capacity, pulmonary artery pressure, and right ventricular systolic functions. In this regard, our findings emphasize the important role of treating NSD patients without delay, given the likelihood of septoplasty to reverse the changes in the pulmonary artery system and to prevent onset of permanent cardiopulmonary dysfunction via amelioration of chronic obstruction of the upper respiratory tract.
The need for biomarkers for acute ischemic stroke (AIS) to understand the mechanisms implicated in pathological clot formation is critical. The levels of the brain natriuretic peptides known as brain ...natriuretic peptide (BNP) and NT-proBNP have been shown to be increased in patients suffering from heart failure and other heart conditions. We measured their expression in AIS clots of cardioembolic (CE) and large artery atherosclerosis (LAA) etiology, evaluating their location inside the clots, aiming to uncover their possible role in thrombosis. We analyzed 80 thrombi from 80 AIS patients in the RESTORE registry of AIS clots, 40 of which were of CE and 40 of LAA etiology. The localization of BNP and NT-BNP, quantified using immunohistochemistry and immunofluorescence, in AIS-associated white blood cell subtypes was also investigated. We found a statistically significant positive correlation between BNP and NT-proBNP expression levels (Spearman's rho = 0.668
< 0.0001 *). We did not observe any statistically significant difference between LAA and CE clots in BNP expression (0.66 0.13-3.54% vs. 0.53 0.14-3.07%,
= 0.923) or in NT-proBNP expression (0.29 0.11-0.58% vs. 0.18 0.05-0.51%,
= 0.119), although there was a trend of higher NT-proBNP expression in the LAA clots. It was noticeable that BNP was distributed throughout the thrombus and especially within platelet-rich regions. However, NT-proBNP colocalized with neutrophils, macrophages, and T-lymphocytes, suggesting its association with the thrombo-inflammatory process.
Objectives The aim of this study was to determine the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in adults with congenital heart disease (CHD) and investigate its relationship ...with ventricular function and exercise capacity. Background NT-proBNP may detect early deterioration in cardiac function. Methods In this cross-sectional study, extensive echocardiography, exercise testing, and NT-proBNP measurements were performed on the same day in consecutive adult patients with CHD. Results In total, 475 patients were included in this study (mean age of 34 ± 12 years, 57% male, 90% New York Heart Association class I). The median NT-proBNP level was 15.1 pmol/l (interquartile range IQR: 7.1 to 31.3 pmol/l), and the NT-proBNP level was >14 pmol/l in 53% of patients. The highest NT-proBNP levels were observed in patients with Fontan circulation (36.1 pmol/l IQR: 14.4 to 103.8 pmol/l) and a systemic right ventricle (RV) (31.1 pmol/l IQR: 21.8 to 56.0 pmol/l), and the lowest values were seen in patients with aortic coarctation (7.3 pmol/l IQR: 2.8 to 19.5 pmol/l). NT-proBNP levels correlated with age (r = 0.39, p < 0.001) and were higher in women (median of 21.7 vs. 10.4 pmol/l; p < 0.001). In patients with aortic stenosis or aortic coarctation, NT-proBNP levels correlated with diastolic function parameters of E/E′ ratio (r = 0.40, p < 0.001) and left atrial dimension (r = 0.36, p < 0.001). In patients with a systemic RV, NT-proBNP levels correlated with RV annulus diameter (r = 0.31, p = 0.024). In patients with tetralogy of Fallot, the strongest correlations were observed with left atrial dimension (r = 0.46, p < 0.001) and left ventricular ejection fraction (r = 0.37, p < 0.001). NT-proBNP levels were associated with exercise capacity (n = 198) (maximum workload: β = −0.08, p = 0.021) and peak oxygen uptake (β = −0.012, p = 0.011) in a multivariable regression model adjusted for age and sex. Conclusions NT-proBNP levels in adults with CHD clearly differ by diagnosis and are related to echocardiographic parameters and exercise capacity. Disease-specific correlations contribute to the understanding of the main hemodynamic problems per diagnosis. Follow-up data are needed to elucidate the additional prognostic value.
Although heart failure (HF) has been linked to bisphenol A (BPA), few studies have investigated the cut-off values for the effects of urinary BPA levels on heart failure risk. The association between ...urinary BPA levels and HF prognosis has not been investigated.
This study included 11,849 adults over 20 years old using information from the National Health and Nutrition Examination Survey (NHANES), which was conducted from 2003 to 2016. The relationship between urinary BPA levels and the risk of HF was determined via a multivariable logistic regression model, and restricted cubic spline (RCS) methods were used to determine the cut-off for the effect of BPA levels on HF risk. Based on the available NT-proBNP concentration data from the NHANES (2003-2004), multivariable linear regression was applied to determine the linear association between the NT-proBNP concentration and urinary BPA concentration.
The results revealed a positive correlation between a urinary BPA concentration in the fourth quartile and the occurrence of heart failure OR 1.49, 95% CI (1.09, 2.04),
= 0.012. A one-unit increase (1 ng/mg creatinine) in the ln-transformed BPA concentration was linked to a 15% increase in the incidence of HF OR 1.15, 95% CI (1.03, 1.29),
= 0.014. The cut-off urinary BPA concentration for HF risk was 1.51 ng/mg creatinine. There was a positive correlation between urinary BPA and NT-proBNP concentrations
= 0.093, 95% CI (0.014, 0.171),
= 0.02 in males, but there was no linear association
= 0.040, 95% CI (-0.033, 0.113),
= 0.283 in females.
Increased urinary BPA levels are linked to an increased risk of heart failure and poor prognosis. There is a significant increase in the risk of heart failure if the urinary concentration of BPA exceeds 1.51 ng/mg creatinine.
Background: This study aimed to investigate the prognostic value of N-terminal B-type natriuretic peptide (NT-proBNP) in pregnancies with isolated chronic hypertension (HT).
Method: 34 pregnant women ...with chronic HT and 40normotensive controls were enrolled. The association between plasma NT-proBNP levels obtained in the first trimester and perinatal complications were evaluated.
Results: NT-proBNP levelsstrongly predicted low birth weight (AUC=0.842, p<0.001). NT-proBNP and birth weight were negatively correlated (r= -0.323, p=0.005). NT-proBNP was found to be an individual determinant of low birth weight in univariate analysis (OR:1.03; 95%CI:1.01-1.04).
Conclusion: NT-proBNP levels can be useful to predict low birth weight in pregnancies with chronic HT.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
In polytrauma patients with AKI continuous venovenous hemodialysis (CVVHD) with medium cutoff membrane filters is commonly adopted to increase the removal of both myoglobin and inflammatory ...mediators, but its impact on increasing molecular weight markers of inflammation and cardiac damage is debated.
Twelve critically ill patients with rhabdomyolysis (4 burns and 8 polytrauma patients) and early AKI requiring CVVHD with EMIc2 filter were tested for 72 h on serum and effluent levels for NT-proBNP, procalcitonin (PCT), myoglobin, C-reactive protein (CRP), alpha1-glycoprotein, albumin, and total protein.
The sieving coefficients (SCs) for proBNP and myoglobin were as higher as 0.5 at the start, decreased to 0.3 at the 2nd h, and then slowly declined to the final value of 0.25 and 0.20 at the 72nd h, respectively. PCT showed a negligible SC at the 1st h, a peak of 0.4 at the 12th h, and a final value of 0.3. SCs for albumin, alpha1-glycoprotein, and total protein were negligible. A similar trend was observed for the clearances (17-25 mL/min for proBNP and myoglobin; 12 mL/for PCT; <2 mL/min for albumin, alpha1-glycoprotein, and total protein). No correlation was found between systemic determinations and filter clearances of proBNP, PCT, and myoglobin. Net fluid loss/hour during CVVHD positively correlated with systemic myoglobin for all patients and NT-proBNP in the burn patients.
CVVHD with EMiC2 filter showed low clearances for NT-proBNP and procalcitonin. CVVHD did not significantly affect the serum levels of these biomarkers, which could be adopted in the clinical management of early CVVHD patients.
Abstract
Background
Even though hyperglycemia is a well-known cardiovascular risk factor, the absolute risk of cardiovascular events varies to a great extent within each glycemic category. The aim of ...this study is to evaluate whether N-terminal pro-B natriuretic peptide (NT-ProBNP) could help identify subjects at higher cardiovascular risk, independently of blood glucose levels.
Methods
Serum NT-ProBNP levels were measured in 5502 people aged 45–79 years without heart failure from the general population (3380 with normoglycemia, 1125 with pre-diabetes and 997 with diabetes) that participated in the 1999–2004 cycles of the National Health and Nutrition Examination Survey. We applied Cox and Fine Gray models adjusted for cardiovascular risk factors to evaluate the association between NT-ProBNP levels and all-cause and cardiovascular mortality through December 2015.
Results
After a median follow-up of 13 years, 1509 participants died, 330 of cardiovascular causes. In the multivariable-adjusted models, compared with participants with NT-ProBNP < 100 pg/ml, those with levels 100–300 pg/ml and ≥ 300 pg/ml had a higher incidence of both all-cause mortality (HR 1.61, 95% CI 1.12–2.32, p = 0.012 and HR 2.96, 95% CI 1.75–5.00, p < 0.001, respectively) and cardiovascular mortality (HR 1.57, 95% CI 1.17–2.10, p = 0.011 and HR 2.08, 95% CI 1.47–2.93, p < 0.001, respectively). The association was consistent in subgroup analyses based on glycemic status, obesity, age and sex.
Conclusions
Elevated NT-ProBNP is independently associated with all-cause and cardiovascular mortality in the general population and could help identify patients at the highest risk. Further studies are needed to evaluate whether intensification of treatment based on biomarker data might lead to improvements in cardiovascular risk reduction.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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