Plasma N-terminal pro-brain natriuretic peptide levels in elderly patients with isolated diastolic dysfunction

Objective To investigate plasma N-terminal pro-brain natriuretic peptide (NT-BNP) levels and to assess their clinical significance in elderly patients with isolated diastolic dysfunction. Methods Plasma NT-BNP level were measured by electrochemiluminescence immunoassay in 34 symptomatic patients (Group 1), 34 asymptomatic patients (Group 2) with isolated diastolic dysfunction, and in 16 elderly healthy subjects (control group, Group 3), serving controls. Colored Doppler echocardiography was performed to evaluate the patients' cardiac structures and functions. Results The plasma NT-BNP level in Group 1 was significantly higher than those in Group 2 and Group 3 and increased with the severity of heart failure. There was no significant difference of plasma NT-BNP levels between Group 2 and Group 3 (p>0.05). A NT-BNP value of 102.75 pg/mL showed a sensitivity of 88.2%, a specificity of 87.5%, and an accuracy of 88.1% for diagnosing diastolic dysfunction. Patients with restrictive filling pattern on echocardiography had higher NT-BNP levels than those of impaired relaxation pattern (1961.2±304.9 versus 460.1±92.7pg/mL, p<0.001). Conclusion The elevation of plasma NT-BNP level in elderly patients with isolated diastolic dysfunction correlates with the severity of their diastolic abnormalities. The level of plasma NT-BNP has an important clinical value in the diagnosis of elderly patients with isolated diastolic dysfunction.

Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Acute Pulmonary Embolism

Patients with pulmonary embolism (PE) have a high risk of death and it is important to recognize factors associated with high mortality. N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP) has recently emerged as a promising biomarker for risk assessment in acute pulmonary embolism (PE). The aim of this study is to detect the in hospital prognostic value of NT-pro BNP in patients with acute (PE). Methods: This study included 64 patients diagnosed as (PE) with the mean age of 59.1 ± 16.5 years, 40 patients of them (62.5%) were male. All patients were subjected to 12 leads ECG. X-ray chest, laboratory tests including D-Dimer, troponin I, NT-pro BNP, Doppler ultrasound for the venous system of both lower limbs, Echocardiograhy and 64 multislices CT pulmonary angiography. Results: According to the admission level of NT-pro BNP our patients were divided into two groups: group I included 22 patients with normal NT-pro BNP (less than 300 pg/ml), and group II included 42 patients with elevated NT-pro BNP (more than or equal 300 pg/ml). Patients in group II were found to have a significantly higher incidence of heart failure (28.6% Vs 4.6%, p = 0.025), impaired kidney function (serum creatinine was 1.7 ± 0.6 Vs 1.1 ± 0.2, p = 0.018), tachypnea (85.7% Vs 54.5%, p = 0.006) and cardiogenic shock (26.2% Vs 0%, p = 0.014) but a significantly lower incidence of chest pain (21.4% Vs 45.5%, p = 0.04) and lower left ventricular ejection fraction (51.3% ± 16.9% Vs 67.3% ± 12.8%, p = 0.043) compared to group I. There were a significantly higher treatment with thrombolytic therapy (35.7% Vs 9.1%, p=0.021) and positive inotropics (35.71% Vs 4.55%, p = 0.006) in group II compared to group I. Also group II had a higher need for mechanical ventilation (26.12% Vs 4.55%, p = 0.04) and a longer in hospital stay (19.5 ± 10.3 Vs 5.3 ± 4.5, p = 0.001) than group I. The in hospital mortality was significantly higher in group II compared to group I (19.05% Vs 0.0%, p = 0.042). Conclusion: Elevated NT-pro BNP levels in patients with (PE) are associated with worse short term prognosis in terms of higher morbidity and mortality and it could be used as a valuable prognostic parameter and good indicator for the need of more aggressive therapy.

Effect of atorvastatin on serum oxidative stress and N-terminal brain natriuretic peptide expression in rats

Objective:To investigate the effect of atorvastatin on serum oxidative stress and N-terminal brain natriuretic peptide expression in rats.Methods:A total of 40 healthy male SD rats were randomly divided into the sham group(Croup A,n=10,saline 5 mL/d),ischemia-reperfusion group(Group B,n=10,saline S mL/d),atorvastatin group(Group C,n=10.atorvastatin 20 mg/kg·d),atorvastatin + N-amino-arginine group(Group D,n=10,atorvastatin 20 mg/kg·d + N-amino arginine 15 mg/kg).Myocardial ischemia-reperfusion rat model was eslablished after 3 days of gavage.N-amino arginine 15 mg/kg was given by tail vein injection 15 min before ischemia.After reperfusion,enzymology indicators such us creatine kinase(CK) and lactate dehydrogenase and the oxidative stress parameters such as nitric oxide(NO),malondialdehyde(MDA) and total superoxide dismutase(TSOD),and n-terminal pro-brain natriuretic peptide(NT-proBNP)expression was detected by immunohistochemistry.Results:LDH and CK levels of group A were significantly lower than the outer three groups,and group B was the highest.There was significant difference between group B and group C(P<0.05),and no significant difference between group B and group D(P>0.05).MDA levels in group B were significantly higher than the other three groups.The lowest was group A,followed by group C,the difference among groups was significantly(P<0.05).TSOD and NO levels in group B was the lowest,the level in group A was the highest,followed by group C,the difference among groups was significant(P<0.05).NT-proBNP level in group B was significantly higher than the other three groups,the lowest was group A,followed by group C,the difference among groups was significant(P<0.05).Conclusions:Atorvastatin has a protective effect on the myocardial injury in the myocardial ischemia and reperfusion rats.It can increase NO synthesis and decrease MDA content,increase serum TSOD activity and the oxidative stress effect,meanwhile protect myocardial cells and reduce myocardial injury.

Diagnostic Value of Combined Detection of Galectin-3 and N-Terminal B-Type Natriuretic Peptide in Patients with Acute Heart Failure

Background: Acute heart failure timely and effective diagnosis and treatment directly affects the prognosis of patients, so early diagnosis of acute heart failure treatment is very important. The current diagnosis of acute heart failure has yet to be further improved. To investigate the relationship between plasma levels of Galectin-3 and NT-proBNP in cardiac structure and function in patients with acute heart failure (AHF) Early detection of failure. Methods: The clinical data of 86 patients with acute heart failure in our hospital were analyzed and followed up. Twenty-six healthy subjects with normal cardiac function were used as control group. The plasma Galectin-3 and NT-proBNP levels were compared between the two groups to observe the value of plasma Galectin-3 combined with NT-proBNP in the diagnosis of acute heart failure. Results: There was no significant difference in the level of Galectin-3 and NT-proBNP between heart function group II and control group, and the levels of cardiac function III and IVG plasma Galectin-3 and NT-proBNP were significantly higher in patients with heart failure Compared with the healthy control group, the patients’ LVEF decreased and their cardiac function increased. The levels of plasma Galectin-3 and NT-proBNP increased significantly (P 0.01). Multivariate Logistic regression analysis demonstrated that plasma levels of Galectin-3 and NT-proBNP were independent of cardiac function. The area under the ROC curve for the combined detection of plasma Galectin-3 and NT-proBNP was greater than the area under the two alone tests. Conclusion: The combined detection of Galectin-3 and NT-proBNP has high sensitivity and specificity in the diagnosis of acute heart failure and can be used as a new detection mode.

Association of N-terminal pro-brain natriuretic peptide with the severity of coronary artery disease in patients with normal left ventricular ejection fraction

Backround N-terminal pro-brain natriuretic peptide （NT-proBNP） is a reliable predictor in acute coronary artery disease （CAD）. Little is known about patients with stable CAD, especially Chinese patients with CAD. The aim of the present study was to investigate the association of NT-proBNP levels with the severity of CAD in patients with normal left ventricular ejection fraction. Methods A total of 658 consecutive patients were divided into two groups based on angiograms： CAD group （n=484） and angiographic normal control group （n=174）. The severity of CAD was evaluated by modified Gensini score, and its relationship with NT-proBNP was analyzed. Results The prevalence of risk factors such as age, male gender, diabetes mellitus （DM）, dyslipidemia, smoking, and family history of CAD in the CAD group were higher than that in the control group. In multivariate regression model analysis, age, gender, and DM were determinants of the presence of CAD. NT-pro BNP was found to be an independent predictor for CAD （OR：1.66 （95% CI： 1.06-2.61）, P 〈0.05）. In a receiver operating characteristic （ROC）curve analysis, an NT-proBNP value of 641.15 pmol/L was identified as a cut-off value in the diagnosis or exclusion of CAD （area under curve （AUC）=0.56, 95% CI： 0.51-0.61）. Furthermore, NT-proBNP was positively correlated with Gensini score （r=0.14, P 〈0.001） in patients with CAD. Conclusion NT-proBNP was an independent predictor for Chinese patients with CAD, suggesting that the NT-proBNP level might be associated with the presence and the severity of CAD.

Predictive value of N-terminal pro-brain natriuretic peptide in combination with the sequential organ failure assessment score in sepsis

Background The prognostic power of n-terminal pro-brain natriuretic peptide （NT-proBNP） in sepsis is disputable and unstable among different models. We attempt to evaluate the prognostic potential of NT-proBNP in combination with the sequential organ failure assessment （SOFA） score in sepsis. Methods In this retrospective study, 100 consecutive sepsis patients were enrolled. Clinical data such as admission SOFA, the Acute Physiologic and Chronic Health Evaluation score, shock prevalence, use of lung protective ventilation, vasopressors, and glucocorticoids were recorded. Additionally, serum creatinine （Scrl and Scr3） and NT-proBNP （NT-proBNP1 and NT-proBNP3） were assayed and evaluated at admission and on day 3 respectively. Results ANT-proBNP （NT-proBNP3 minus NT-proBNP1） （P 〈0.001, Hazard ratio （HR）=1.245, 95% confidence interval （CI）, 1.137-1.362） and admission SOFA （P 〈0.001, HR=1.197, 95% CI, 1.106-1.295） were independently related to in-hospital mortality. Their combination was a more robust predictor for in-hospital mortality than either of them individually. Patients with high ANT-proBNP and SOFA had the poorest prognosis. Conclusions In our study, both ANT-proBNP and SOFA were independent predictors of septic patients＇ prognosis. Moreover, the combination of ,~NT-proBNP and admission SOFA provided a novel strategy that contained information regarding both the response to treatment and sepsis severity.

Association between plasma brain natriuretic peptide/N-terminal pro-brain natriuretic peptide levels and atrial fibrillation： evidence from a meta-analysis

Background Several small sample-size observational studies evaluated the association of plasma brain natriuretic peptide （BNP） or N-terminal pro-brain natriuretic peptide （NT-proBNP） with atrial fibrillation （AF）,but the results were contradictory.We aimed to perform a meta-analysis of relevant studies to evaluate the availability of this association.Methods We performed an extensive literature search on PubMed,Web of Science （WOS） and the Cochrane Library databases.Pooled standardized mean difference （SMD） and 95% confidence interval （CI） were calculated to assess the strength of association using random effects models.We performed sensitivity and subgroup analyses to explore the potential sources of heterogeneity.We also estimated publication biases.Statistical analyses were performed using the STATA 12.0 software.Results A total of 11 studies including 777 cases and 870 controls were finally analyzed.Overall,the brain natriuretic peptide/N-terminal pro-brain natriuretic peptide levels were higher in atrial fibrillation patients than controls without atrial fibrillation.Results showed that the SMD in the natriuretic peptide levels between cases and controls was 2.68 units （95%CI 1.76 to 3.60）; test for overall effect z-score=5.7 （P 〈0.001）.There was significant heterogeneity between individual studies （I2=97.8%; P 〈0.001）.Further analysis revealed that differences in the assay of natriuretic peptide possibly account for this heterogeneity.Conclusions Increased BNP/NT-proBNP levels were associated with the presence of atrial fibrillation.This finding indicates that BNP/NT-proBNP may prove to be a biomarker of an underlying predisposition to AF.

Association between high-sensitivity cardiac troponin T and N-terminal pro-brain natriuretic peptide in a community based population

Background N-terminal pro-B-type natriuretic peptide （NT-proBNP） and high-sensitivity cardiac troponin T （hs-cTnT） are excellent biomarkers for detecting heart failure and subclinical myocardial injury.However,it remains unclear whether subclinical myocardial injury is associated with NT-proBNP elevation in a community based population.Methods In a community based study,levels of hs-cTnT and of NT-proBNP were determined in 1 497 participants older than 45 years.The lower detection limit of the hs-cTnT assay used in the present study was 0.003 ng/ml.The association of hs-cTnT levels and NT-proBNP levels was analyzed.Results When the subjects with undetectable （〈0.003 ng/ml）,intermediate （0.003-0.014 ng/ml）,and elevated （≥0.014 ng/ml） levels of hs-cTnT were compared （r=0.175,P 〈0.001）,a strong association between the hs-cTnT levels and NT-proBNP levels was observed （β=-0.206,P 〈0.001; β=-0.118,P 〈0.001,respectively）.In multivariable analyses,older age and hs-cTnT were positively and independently associated with NT-proBNP levels （β=0.341,P 〈0.001; β=0.143,P 〈0.001,respectively）,and male gender and the levels of eGFR were inversely and independently associated with NT-proBNP levels.When the subjects with normal or elevated NT-proBNP were analyzed separately,the hs-cTnT level was not an independent predictor for the NT-proBNP level in the normal NT-proBNP group,whereas the hs-cTnT level was the only independent predictor for NT-proBNP level in the elevated NT-proBNP group （β=0.399,P 〈0.01）.Conclusions In this community based population,NT-proBNP elevation was common.In addition to female gender and older age,subclinical myocardial injury indicated by the hs-cTnT level was another important factor in NT-proBNP elevation.

培哚普利联合氨氯地平对原发性高血压伴左心室肥厚的逆转作用及对患者血浆N末端B型利钠肽原水平的影响

目的:探究培哚普利联合氨氯地平对原发性高血压伴左心室肥厚的逆转作用及对血浆N末端B型利钠肽原(NT-ProBNP)水平的影响。方法:选择原发性高血压伴左心室肥厚患者138例为研究对象,按随机数表法分为三组,均46例。对照组1予以氨氯地平治疗,对照组2予以培哚普利治疗,观察组采用培哚普利联合氨氯地平治疗。比较临床疗效、治疗前后血压情况、舒张末期左室内径(LVDd)、室间隔厚度(I与T)、左室后壁厚度(PWT)、左室重量指数(LVMI)及NT-ProBNP、同型半胱氨酸(Hcy)心钠肽(ANP)水平。结果:观察组总有效率为95.65%(44/46)高于对照组1[80.43%(37/46)]和对照组2[76.09%(35/46)](均P<0.05),对照组1和对照组2比较无统计学差异(P>0.05)。治疗前,三组收缩压、舒张压、I与T、PWT、LVMI及血清NT-ProBNP、Hcy、ANP水平比较,差异无统计学意义(均P>0.05),治疗后,观察组收缩压(127.87±13.66与136.46±15.73与135.00±15.98)、舒张压(81.07±5.58与83.98±7.16与85.57±7.22)、LVDd(46.48±2.24与48.37±3.62与48.30±3.57)、I与T(10.00±1.38与11.20±1.50与11.24±1.55)、PWT(10.52±1.35与12.24±1.40与12.37±1.39)、LVMI(124.57±10.80与145.13±10.27与144.93±10.34)、NT-ProBNP(64.53±15.63与75.23±18.46与78.15±18.54)、Hcy(8.93±2.68与15.48±4.66与14.88±4.62)、ANP(139.95±38.64与216.84±59.15与213.87±59.23)水平均较对照组1和对照组2下降(均P<0.05),对照组1和对照组2比较无统计学差异(P>0.05)。结论:培哚普利联合氨氯地平对原发性高血压伴左心室肥厚治疗效果较好,可有效降低血压、改善左室相关指标,并降低NT-Pro BNP水平。

Plasma N-terminal pro-Brain natriuretic peptide levels after hybrid therapy with pulmonary vein isolation and amiodarone for atrial fibrillation

Background The purpose of this study was to investigate the effect of hybrid therapy and the relationship between the plasma N-terminal pro-Brain natriuretic peptide （NT-pro BNP） levels and the recurrence rate of the atrial fibrillation （AF） patients underwent pulmonary vein isolation （PVI） with or without amiodarone. Methods There were two groups in this study： control group and hybrid group. In the control group, 54 patients （36 males, 54±13 years） including paroxysmal （PAF） 22, persistent （Pers-AF） 15, and permanent AF （perm-AF） 17, respectively, underwent the PVI procedure only; In the hybrid, 63 AF patients （41 males, 53±12 years） including PAF 24, Pers-AF 18, and perm-AF 21, respectively,underwent the PVI procedure and used amiodarone to enhance the effect of PVI. Blood samples were collected before and 3 months after PVI. NT-pro BNP concentrations were determined by immunoassays. Results In the control group, AF recurred in 29 patients （PAF 5 in 22, Pers-AF 11 in 15, and perm-AF 13 in 17） after the initial PVI procedure; And in the hybrid group, AF recurrred in 20 patiens （PAF 3 in 24, Pers-AF 7 in 18, and perm-Af 11 in 21 ）. The average recurrent rate decreased significantly in the hybrid group （53.7% vs 31.7%, P0.01）. While the NT pro- BNP level （pg/mL） was significantly different between the 2 groups （PAF 294.34±54.4 versus 241.69±17.6 pg/mL, P=0.047; Pers-AF 487.51±47.9 versus 248.76±19.4, P=0.001; Perm-AF 490.91±38.3 versus 300.86±31.8, P=0.032）, While the NT pro- BNP level was also much lower in hybird group than control group in total （263.43±26.1 versus 409.88±49.7, P=0.02）. Conclusions Sinus rhythm（SR）following AF ablation is associated with a dramatic decrease in NT-pro BNP. The hybrid group which had the administration of amiodarone after PVI would significantly decrease the plama NT pro-BNP levels and the recurrent rate of AF.

Association between N-terminal proB-type Natriuretic Peptide and Depressive Symptoms in Patients with Acute Myocardial Infarction

Background： While depression and certain cardiac biomarkers are associated with acute myocardial infarction （AM1）, the relationship between them remains largely unexplored. We examined the association between depressive symptoms and biomarkers in patients with AMI. Methods： We performed a cross-sectional study using data from 103 patients with AM1 between March 2013 and September 2014. The levels of depression, N-terminal proB-type natriuretic peptide （NT-proBNP）, and troponin 1 （Tnl） were measured at baseline. The patients were divided into two groups： those with depressive symptolns and those without depressive symptoms according to Zung Self-rating Depression Scale （SDS） score. Baseline comparisons between two groups were made using Student＇s t-test for continuous variables, Chi-square or Fisher＇s exact test for categorical variables, and Wilcoxon test for variables in skewed distribution. Binomial logistic regression and multivariate linear regression were performed to assess the association between depressive symptoms and biomarkers while adjusting for demographic and clinical variables. Results： Patients with depressive symptoms had significantly higher NT-proBNP levels as compared to patients without depressive symptoms （ 1135.0 [131.5, 2474.0] vs. 384.0 [ 133.0, 990.0], Z = -2.470, P 0.013）. Depressive symptoms were associated with higher NT-proBNP levels （odds ratio [OR] 2.348, 95% CI： 1.344 to 4.103, P= 0.003） and higher body mass index （OR = 1.169, 95% confidence interval [CI]： 1.016 to 1.345, P = 0.029）. The total SDS score was associated with the NT-proBNP level （[3 ： 0.327, 95% CI：1.674 to 6.119, P = 0.001） after multivariable adjustment. In particular, NT-proBNP was associated with three of the depressive dimensions, including core depression （β = 0.299, 95% CI：0.551 to 2.428, P=0.002）, cognitive depression （β= 0.320, 95% CI：0.476 to 1.811, P=0.001）, and somatic depression （β= 0.333, 95% CI： 0.240 to 0.847, P = 0.001）. Neither the overall depressive symptomatology nor the individual depressive dimensions were associated with TnI levels. Conclusions： Depressive symptoms, especially core depression, cognitive depression, and somatic depression, were related to high NT-proBNP levels in patients with AMI.

Decrease of plasma N-terminal pro p-type natriuretic peptide as a predictor of clinical improvement after cardiac resynchronization therapy for heart failure

Background N-terminal pro β-type natriuretic peptide （NT pro BNP） has been shown to predict the prognosis and could guide the treatment of heart failure. We aimed to investigate the values of NT pro BNP in predicting the clinical response to cardiac resynchronization therapy （CRT）. Methods A total of 44 patients with chronic heart failure （34 male and 10 female, mean age of （58±13） years, New York Heart Association （NYHA） class 3.3±0.5, QRS duration （150±14） milliseconds） who underwent successful implantation of a CRT system were enrolled in this study. Pharmacotherapy remained stable during the first 3 months of follow-up. Plasma levels of NT pro BNP were evaluated before and 3 months after implantation. Clinical, echocardiographic and exercise parameters were monitored at each clinical visit after CRT implantation. Receiver operating characteristic analysis and a paired ttest were performed to analyze the data. Results After a mean of （16.3±5.5） months of follow-up, 11 nonresponders were identified. CRT resulted in a significant reduction in NT pro BNP （（1.70±1.28） vs （1.07±0.88） pmol/ml, P 〈0.001） in responders. Percentage change in NT pro BNP level （△BNP%） was a statistically significant predictor of long term clinical improvement at 3 months of follow-up. Conclusions △BNP% from baseline to 3 months of follow-up is a predictor of long term response to CRT. NT pro BNP may be a simple method for monitoring the effects of CRT.

N-terminal pro-B-type natriuretic peptide and diastolic function measurements by adenosine stress echocardiography in prediction of coronary stenosis in patients

Background Stress echocardiography is mainly used in detection of coronary artery disease （CAD） and to assess risk.This study aimed to use adenosine stress echocardiography （ASE） and N-terminal pro-B-type natriuretic peptide （NT-proBNP） to noninvasively assess coronary stenosis in patients with chest pain syndromes or anginal equivalent.Methods NT-proBNP was measured after overnight fast in fifty patients, 42 males and 8 females, who were （57＋11）years old. They then underwent echocardiography before and during adenosine administration. Left ventricular （LV）diastolic function analyzed included mitral annular early （E＇） and late velocity （A＇） both at the mitral septal and lateral level and the mitral inflow to annulus ratio （E/E＇）. Coronary angiography was performed the following day after which patients were assigned to three groups： normal results （16 patients）, stenosis 50%-69%（17 patients） and stenosis≥70% （17 patients）.Results NT-proBNP levels in the groups of stenosis 50%-69% and≥ 70% were significantly higher than that in the group with normal results （P=0.014 and P=0.040）. During adenosine stress, the E/E＇ in the group of stenosis≥70% was higher than in the group of normal results （P=0.024）. E＇lateral/A＇lateral in the group of stenosis 50%-69% and E＇septal/A＇septal and E＇lateral/A＇lateral in the group of stenosis≥70% were also decreased during stress compared with baseline （P=0.003,P=0.001, P=0.022）. The variation of E＇septal/A＇septal before and during adenosine stress （△E＇septal/A＇septal） between the groups of normal results and stenosis ≥70% were significantly different （P=0.001）. By receiver operating characteristic （ROC）, the specificity of △E＇septal/A＇septal ≥0.037 predicting coronary stenosis ＜70% was 94%. The sensitivity and specificity of NT-proBNP≥544.6 fmol/ml in predicting coronary stenosis ≥70% were 93% and 75%, respectively.NT-proBNP inversely correlated with E＇lateral/A＇lateral （r=-0.390, P=0.014） and positively correlated with E/E＇lateral（r=0.550,P=0.001）.Conclusions Adenosine might induce diastolic dysfunction in patients with coronary stenosis more than 70% and NT-proBNP could reflect LV diastolic function to a certain extent. We support the prediction that most patients having chest pain syndromes or anginal equivalent with NT-proBNP＜544.6 fmol/ml and in ASE AE＇septal/A＇septal≥0.037 might be spared coronary angiography.

Analyses of N‑Terminal Pro‑Brain Natriuretic Peptide,Cardiac Troponin T,and Creatine Kinase MB in Pericardial Fluid in Sudden Cardiac Death Caused by Ischemic Heart Disease

Background:Biochemical analyses of N‑terminal pro‑brain natriuretic peptide(NT‑proBNP),cardiac troponin T(cTnT),and creatine kinase MB(CK‑MB)have been reported to be valuable for the auxiliary diagnosis of sudden cardiac death(SCD)in previous forensic studies.Aims and Objectives:The present study aimed to evaluate the diagnostic efficiency of combined analyses of NT‑proBNP,cTnT and CK‑MB in the pericardial fluid for forensic diagnosis of SCD caused by ischemic heart disease.Materials and Methods:Levels of NT‑proBNP,cTnT,and CK‑MB in the pericardial fluid of 132 medicolegal autopsy cases were obtained through electrochemiluminescence method.Results:NT‑proBNP,cTnT,and CK‑MB levels were significantly elevated in SCD cases(P<0.05).Receiver‑operating characteristics(ROC)analysis showed that NT‑proBNP,cTnT,and CK‑MB have diagnostic value for the diagnosis of SCD:NT‑proBNP,cutoff value of 2236 pg/ml;cTnT,cutoff value of 199.51 ng/ml;CK‑MB:cutoff value of 2742.5 ng/ml,and the combined analyses of these three biomarkers have better diagnostic efficiency than each single biomarker alone.Moreover,the causes of SCD were sub‑divided into acute ischemic heart disease,acute myocardial infarction(AMI),and recurrent myocardial infarction subgroups for further analysis,which revealed that the ratio of cTnT/CK‑MB could be used to distinguish AMI with the cutoff value of 0.1085 estimated by ROC analysis.Conclusion:These observations suggested that the postmortem biochemical analyses of NT‑proBNP,cTnT,and CK‑MB in the pericardial fluid may assist to diagnose SCD in forensic practice,and the combined analyses of multiple biomarkers have better diagnostic efficiency than each single biomarker alone.On the basis of the postmortem biochemical analyses of NT‑proBNP,cTnT and CK‑MB,combining the ratio of cTnT/CK‑MB could be used to distinguish AMI.

Advances in diagnosis and management of chronic heart failure in China： reference limits of N-terminal-pro-B-type natriuretic peptide, pharmacal management, and community care

Heart failure,the final outcome of various heart diseases,has an increasingly high prevalence in China.Diagnosis,medical treatments,and community managements of heart failure are substantial clinical challenges.N-terminal-pro-B-type natriuretic peptide （NT-proBNP） is a useful biomarker for diagnostic and prognostic predictions in heart failure patients;however,the levels of reference value in normal Chinese populations are lacking.The usage of classic Western medicines has greatly improved;furthermore,the treatment pattem of the integration of Western treatments and traditional Chinese medicine （TCM） is also widely explored.Moreover,community managements of heart failure have been paid more attention and the long-term mechanism is being built.Here,we summarize the range of reference values of NT-proBNP in normal Chinese subjects,current therapies including Western treatments and especially TCM,as well as community care among people with chronic heart failure patients in China.Keywords：chronic heart failure; N-terminal-pro-B-type natriuretic peptide; pharmacology; community care

N-terminal pro-B-type natriuretic peptide levels after hospital discharge in patients with acute myocardial infarction for predicting long term outcome

Background N-terminal-pro-brain natriuretic peptide(NT-pro-BNP)is associated with worse outcome in patients with acute myocardial infarction(AMI). However,the role of short-term follow-up of NT-pro-BNP level remains unclear. Methods Three hundred and sixty-two patients diagnosed with AMI were retrospectively enrolled in this study from March 2014 to March 2017 in our center. Blood samples were obtained at initial admission and again within 1 month after hospital discharge. The univariate and multivariate cox regression analyses including significant covariables were performed on NT-pro-BNP level at admission,discharge,or change from admission to discharge to predict adverse cardiovascular events(MACE)as study endpoints. Results There were 211 cases in NT-pro-BNP decrease group,while 151 cases in NT-pro-BNP increase group. The median follow-up was 365 days(interquartile range[IQR],322-861 days). After adjusting the covariables in the multiple logistic regression analysis,follow-up NT-pro-BNP level was still a significant independent predictor for MACE(OR,1.395;95% CI,1.102-1.869,P=0.005). However,the initial NT-pro-BNP level or change of NT-pro-BNP level had no significant predictive value for MACE. Conclusions A short-term follow-up NT-pro-BNP level after hospital discharge is a powerful prognostic biomarker for MACE in patients with AMI.[S Chin J Cardiol 2019;20(3):168-173]

H-FABP、NT-proBNP与急性心力衰竭患者容量负荷状态及预后的相关性

目的 研究心型脂肪酸结合蛋白(H-FABP)、氨基端脑钠肽前体(NT-proBNP)对急性心力衰竭患者容量负荷状态及预后的评估。方法 本研究为前瞻性研究,以2021年1月至2022年1月于安阳市人民医院急诊住院的老年急性心力衰竭患者83例作为研究组,另选取83例健康者作为对照组。根据相对容量平衡水平,将以上83例患者分为容量超负荷组和非容量超负荷组,对所有出院患者随访3个月,将发生死亡的患者归为死亡组,其余为生存组。比较研究组与对照组不同容量负荷、不同预后的H-FABP、NT-proBNP水平之间的差异,研究H-FABP、NT-proBNP与生存状况以及容量负荷状态的相关性。结果 研究组患者的H-FABP、NT-proBNP水平高于对照组(P<0.001);容量超负荷组患者的H-FABP、NT-proBNP水平高于非容量超负荷组(P<0.05);死亡组患者的H-FABP、NT-proBNP水平高于生存组(P<0.05)。通过相关性分析,患者的死亡以及容量超负荷与H-FABP、NT-proBNP呈现正相关(P<0.001)。结论 H-FABP、NT-proBNP与急性心力衰竭患者容量负荷状态及预后呈现相关性,有助于评估急性心力衰竭的严重程度,对预后不良患者起到积极的指导治疗作用。

NT-pro BNP、Hcy及Apo-A与急性心肌梗死患者心力衰竭程度及预后的相关性

目的:探究N-末端脑钠肽前体(NT-pro BNP)、同型半胱氨酸(Hcy)及载脂蛋白A(Apo-A)与急性心肌梗死(AMI)患者心力衰竭(HF)程度及预后的相关性。方法:选择我院2021年1月至2023年12月收治的100例AMI患者作为研究对象,按有无合并HF设为HF组(n=44)与非HF组(n=56)。检测全部患者血清NT-pro BNP、Hcy及Apo-A水平,以Killip分级评估HF组患者HF程度,将HF组患者按预后情况分为预后良好组(n=24)与预后不良组(n=20)。采用单因素及多因素分析影响AMI患者预后不良的因素,并采用受试者工作曲线(ROC)分析血清NT-pro BNP、Hcy及Apo-A水平预测AMI合并HF患者预后的价值。结果:HF组患者血清NT-pro BNP、Hcy及Apo-A水平高于非HF组(P<0.05)。HFⅣ级组患者血清NT-pro BNP、Hcy及Apo-A水平高于Ⅲ级组、Ⅱ级组,且Ⅲ级组高于Ⅱ级组(P<0.05)。经Spearson相关性分析显示,血清NT-pro BNP、Hcy及Apo-A水平与HF程度均呈正相关(r=0.612、0.505、0.649,P<0.05)。预后良好组与预后不良组患者年龄、高脂血症史、心界扩大、NT-pro BNP、Hcy及Apo-A水平比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄、NT-pro BNP、Hcy及Apo-A为AMI合并HF患者预后的影响因素(P<0.05)。血清NT-pro BNP水平预测水平AMI合并HF患者预后的AUC为0.769(0.617~0.882),灵敏度75.00%,特异度79.17%(P<0.05);血清Hcy水平预测AMI合并HF患者预后的AUC为0.833(0.690~0.928),灵敏度95.00%,特异度58.33%(P<0.05);血清Apo-A水平预测AMI合并HF患者预后的AUC为0.877(0.743~0.957),灵敏度85.00%,特异度91.67%(P<0.05)。结论:血清NT-pro BNP、Hcy及Apo-A水平随AMI患者HF级别递增而上升,且与患者预后密切相关,具有较高预测价值。

急性阵发性房颤患者基线NT-proBNP对胺碘酮复律疗效的影响

目的 探讨N末端B型利钠肽原(N-terminal pro B-type natriuretic peptide,NT-proBNP)在胺碘酮用于急性阵发性房颤(acute atrial fibrillation,AF)复律疗效评估中的价值。方法纳入2019年2月—2022年7月三明市第二医院急诊科明确诊断为AF(非瓣膜病)的68例患者,所有患者排除禁忌后均给予胺碘酮复律治疗,根据复律后转复情况分为2组,即成功转复组(n=57)与转复失败组(n=11)。对比2组症状与体征(心悸、胸痛)、心电图表现(是否合并ST段压低)、既往病史(是否合并糖尿病、高血压病、冠心病等)、房颤持续时间和基线NT-proBNP水平。采用二元logistic回归分析AF患者胺碘酮复律疗效的影响因素。结果 2组胸痛、合并糖尿病、合并冠心病、ST段压低、房颤持续时间、合并高血压比较,差异无统计学意义(P>0.05)。成功转复组心悸发生率为28.07%、NT-proBNP水平为(229.43±7.24)pmol/L,优于转复失败组的63.64%、(679.99±8.67)pmol/L,差异有统计学意义(P<0.05)。入院时存在心悸症状、NT-proBNP是影响AF患者应用胺碘酮转复的主要因素(P<0.05)。结论 胺碘酮对AF(非瓣膜病)患者复律治疗安全有效,入院时存在心悸症状、基线NT-proBNP水平是预测胺碘酮复律成功的重要因素。

NT-proBNP、TSP-2、hs-CRP在非瓣膜性HFrEF患者中的表达及对短期预后的预测价值

目的探讨N端脑钠肽前体(NT-proBNP)、血小板吸附蛋白2(TSP-2)、超敏C反应蛋白(hs-CRP)在非瓣膜性射血分数降低心力衰竭(HFrEF)患者中的表达及对短期预后预测价值。方法选取2018年1月至2021年12月郑州大学第一附属医院收治的120例非瓣膜性HFrEF患者为HFrEF组,60例非瓣膜性射血分数保留心力衰竭(HFpEF)患者为HFpEF组,60例心功能正常心力衰竭(HF)患者为对照组。对比三组NT-proBNP、TSP-2、hs-CRP水平;根据心功能分级将HFrEF组患者分为心功能Ⅱ级、心功能Ⅲ级组、心功能Ⅳ级组,并对比三组NT-proBNP、TSP-2、hs-CRP水平;分析NT-proBNP、TSP-2、hs-CRP各指标之间的相关性;根据随访结果将HFrEF组患者分为预后良好组和预后不良组,并比较两组患者NT-proBNP、TSP-2、hs-CRP水平;分析影响HFrEF患者预后的多因素;分析NT-proBNP、TSP-2对HFrEF患者的短期预后预测价值。结果三组NT-proBNP、TSP-2、hs-CRP水平为:HFrEF组>HFpEF组>对照组,差异有统计学意义(P<0.05);120例非瓣膜性HFrEF患者中,心功能Ⅱ级38例(31.67%)、心功能Ⅲ级46例(38.33%)、心功能Ⅳ级36例(30.00%);三组NT-proBNP、TSP-2、hs-CRP水平为:心功能Ⅳ级组>心功能Ⅲ级组>心功能Ⅱ级组,差异有统计学意义(P<0.05);非瓣膜性HFrEF患者血清NT-proBNP与TSP-2、hs-CRP呈正相关(P<0.05);120例非瓣膜性HFrEF患者中,预后良好79例(65.83%)、预后不良41例(34.17%);患者NT-proBNP、TSP-2、hs-CRP水平为:预后不良组>预后良好组,差异有统计学意义(P<0.05);Logistic回归分析结果显示,NT-proBNP、TSP-2、hs-CRP高表达是非瓣膜性HFrEF患者预后不良的危险因素(P<0.05);NT-proBNP、TSP-2、hs-CRP单独与联合预测非瓣膜性HFrEF患者预后的AUC为0.779、0.907、0.898、0.948,联合预测的AUC高于NT-proBNP、TSP-2、hs-CRP,差异有统计学意义(P<0.05)。结论NT-proBNP、TSP-2、hs-CRP在非瓣膜性HFrEF患者中高表达,三指标联合检测能较好预测患者短期预后。