Value of N-Terminal Pro B-Type Natriuretic Peptide,High-Sensitivity C-Reactive Protein,and Homocysteine Levels in Predicting Cardiovascular Events in Chronic Heart Failure Patients After Discharge

Objective:To investigate the value of N-terminal pro B-type natriuretic peptide(NT-proBNP),high-sensitivity C-reactive protein(hs-CRP),and homocysteine(Hcy)levels in predicting cardiovascular events(CV)in patients with chronic heart failure(CHF).Methods:A total of 63 patients with CHF admitted to our hospital between June 2019 and July 2021 were selected.Their NT-proBNP,hs-CRP,and Hcy levels were detected at discharge,and a 12-month follow-up was done after their discharge to collect clinical data.The collected data were inclusive of data from 21 CHF patients with cardiovascular disease and 42 CHF patients without cardiovascular disease.The effect of NT-proBNP,hs-CRP,and Hcy levels on the occurrence of CV was analyzed.Results:The levels of NT-proBNP,hs-CRP,and Hcy in the group with cardiovascular disease were significantly higher than those in the group without cardiovascular disease(P<0.05);the levels of serum NT-proBNP,hs-CRP,and Hcy at discharge had certain value in predicting short-term CV in CHF patients(P<0.05).Conclusion:NT-proBNP,hs-CRP,and Hcy levels can be used to predict CV in CHF patients,thus having clinical application value.

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.

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.

N-terminal pro-brain natriuretic peptide but not high-sensitivity C-reactive protein is related to severity of coronary artery stenosis in patients with acute coronary syndrome

Objective Biochemical indicators such as N-terminal pro-brain type natriuretic peptide（NT pro-BNP）and high-sensitivity Creactive protein（hsCRP）predict mortality in acute coronary syndrome（ACS）.However,little is known about the relationship of these factors with severity of coronary artery stenosis in patients with.Methods Three hundred and thirty-one subjects including 246 unstable angina pectoris patients and 85 myocardial infarction patients were recruited and classified into two groups：single-vessel disease group（1-vessel disease,n=93）and multiple-vessel disease group（≥2-vessels disease,n=238）according to selective coronary angiography.Plasma levels of NT pro-BNP and hsCRP were measured and severity of coronary stenosis was determined by Gensini score.Results NT pro-BNP but not hsCRP level was higher in patients with myocardial infarction than in patients with unstable angina pectoris.The patients with multiple-vessel disease had significantly higher NT pro-BNP level but not hsCRP compared with those with single-vessel disease.NT pro-BNP levels increased significantly as left ventricle（LV）function decreased,and only NT proBNP but not hsCRP level was related to Gensini score of severity of coronary stenosis in ACS.Conclusion NT proBNP but not hsCRP level is related to severity of coronary artery stenosis in patients in ACS.

Elevated plasma levels of N-terminal pro-brain natriuretic peptide in patients with chronic hepatitis C during interferon-based antiviral therapy

AIM: To investigate plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), an established marker of cardiac function, in patients with chronic hepatitis C during interferon-based antiviral therapy. METHODS: Using a sandwich immunoassay, plasma levels of NT-proBNP were determined in 48 patients with chronic hepatitis C at baseline, wk 24 and 48 during antiviral therapy and at wk 72 during follow-up.RESULTS: Plasma NT-proBNP concentrations were significantly increased (P < 0.05) at wk 24, 48 and 72 compared to the baseline values. NT-proBNP concentrations at baseline and wk 24 were closely correlated (r = 0.8; P < 0.001). At wk 24, 7 (14.6%) patients had NT-proBNP concentrations above 200 ng/L compared to 1 (2%) patient at baseline (P = 0.059). Six of these 7 patients had been treated with high-dose IFN-α induction therapy. In multiple regression analysis, NT-proBNP was not related to other clinical parameters, biochemical parameters of liver disease or virus load and response to therapy.CONCLUSION: Elevated levels of NT-proBNP during and after interferon-based antiviral therapy of chronic hepatitis C may indicate the presence of cardiac dysfunction, which may contribute to the clinical symptoms observed in patients during therapy. Plasma levels of NT-proBNP may be used as a diagnostic tool and for guiding therapy in patients during interferon-based antiviral therapy.

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.

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 milrinone on the cardiac function and N-terminal pro-brain natriuretic peptide levels in patients with senile refractory heart failure

Objective:To study the effect of milrinone on the cardiac function and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with senile refractory heart failure. Methods:90 patients with senile refractory heart failure who were treated in our hospital between August 2013 and August 2016 were collected and divided into control group (n=45) and observation group (n=45) according to the random number table. The control group received regular clinical treatment, and the observation group received regular + milrinone treatment. The cardiac function and serum NT-proBN contents were compared between two groups of patients before and after treatment.Results: Before treatment, the differences in ultrasound and serum cardiac function indexes and serum NT-proBN levels were not statistically significant between two groups of patients. After treatment, ultrasound serum cardiac function parameter LVEDD level in observation group was lower than that in control group while CI and SV levels were higher than those in control group;serum cardiac function indexes Cys-C, GDF-15, sST2 and H-FABP contents were lower than those in control group;serum NT-proBNP content was lower than that in control group.Conclusion: Milrinone therapy can optimize the cardiac function and reduce the serum NT-proBN levels in patients with senile refractory heart failure.

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.

Growth differentiation factor-15 combined with N-terminal prohormone of brain natriuretic peptide increase 1-year prognosis prediction value for patients with acute heart failure: a prospective cohort study

Background:Clinical assessment and treatment guidance for heart failure depends on a variety of biomarkers.The objective of this study was to investigate the prognostic predictive value of growth differentiation factor-15(GDF-15)and N-terminal prohormone of brain natriuretic peptide(NT-proBNP)in assessing hospitalized patients with acute heart failure(AHF).Methods:In total,260 patients who were admitted for AHF in the First Affiliated Hospital of Nanjing Medical University were enrolled from April 2012 to May 2016.Medical history and blood samples were collected within 24 h after the admission.The primary endpoint was the all-cause mortality within 1 year.The patients were divided into survival group and death group based on the endpoint.With established mortality risk factors and serum GDF-15 level,receiver-operator characteristic(ROC)analyses were performed.Cox regression analyses were used to further analyze the combination values of NT-proBNP and GDF-15.Results:Baseline GDF-15 and NT-proBNP were significantly higher amongst deceased than those in survivors(P<0.001).In ROC analyses,area under curve(AUC)for GDF-15 to predict 1-year mortality was 0.707(95%confidence interval[CI]:0.648–0.762,P<0.001),and for NT-proBNP was 0.682(95%CI:0.622–0.738,P<0.001).No statistically significant difference was found between the two markers(P=0.650).Based on the optimal cut-offs(GDF-15:4526.0 ng/L;NT-proBNP:1978.0 ng/L),the combination of GDF-15 and NT-proBNP increased AUC for 1-year mortality prediction(AUC=0.743,95%CI:0.685–0.795,P<0.001).Conclusions:GDF-15,as a prognostic marker in patients with AHF,is not inferior to NT-proBNP.Combining the two markers could provide an early recognition of high-risk patients and improve the prediction values of AHF long-term prognosis.Clinical trial registration:ChiCTR-ONC-12001944,http://www.chictr.org.cn.

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 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.

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.

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.

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.

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.

Value of neutrophil/lymphocyte ratio,N-terminal pro-B-type natriuretic peptide,urea,and creatinine for the prediction of acute kidney injury in acute heart failure:a retrospective observational study

Objective:Early identification of acute kidney injury(AKI)is essential to improve the prognosis of patients with acute heart failure(AHF).We aimed to determine the utility of neutrophil/lymphocyte ratio(NLR),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),urea,and creatinine(Cr),as well as combinations of these,for the prediction of AKI in patients with AHF.Methods:A total of 153 patients with AHF under the care of Sun Yat-sen Memorial Hospital,Sun Yat-sen University from October 2009 to October 2019 were included in this retrospective observational study.Their NLR,NT-proBNP,urea,and Cr concentrations were measured on admission.AKI was defined using the Acute Kidney Injury Network criteria.Receiver operating characteristic(ROC)curves,the areas under the curves(AUCs),sensitivity,and specificity were employed to evaluate the ability of each biomarker and their combinations to identify AKI.This study was approved by the Ethics Committee of Sun Yat-sen Memorial Hospital,Sun Yat-sen University(approval No.SYSEC-KY-KS-2021-126)on June 22,2021.Results:Forty-six(30.1%)participants developed AKI during hospitalization.The NLR and NT-proBNP of the participants with AKI were higher than those without(NLR:median 7.886 vs 4.717,P<0.0001;NT-proBNP,median 6774 vs 2786pg/mL,P<0.0001).ROC analyses demonstrated that high NLR and NT-proBNP were associated with higher incidences of AKI(NLR:cut-off 5.681,AUC 0.716,sensitivity 58.9%,specificity 80.4%;NT-proBNP:cut-off 5320pg/mL,AUC 0.700,sensitivity 72.9%,specificity 65.2%).Moreover,a combination of NLR,NT-proBNP,urea,and Cr yielded an AUC of 0.815,sensitivity 80.4%,and specificity of 74.8%.In addition,the AUCs for the prediction of AKI in the participants with New York Heart Association(NYHA)classes II,III,and IV were 0.936,0.860,and 0.772,respectively,using this combination.Conclusion:A combination of NLR,NT-proBNP,urea,and Cr,measured at admission,may represent a promising tool for the prediction of AKI in patients with AHF.This method performs best for AKI risk assessment in patients with NYHA II,followed by those with NYHA III or IV.

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]

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.

Prediction about severity and outcome of sepsis by proatrial natriuretic peptide and pro-adrenomedullin

Objective： Measurement of biomarkers is a potential approach to early prediction of the risk of mortality in patients with sepsis. The aim of the present study was to evaluate the prognostic value of pro-atrial natriuretic peptide （pro-ANP） and pro-adrenomedullin （pro- ADM） levels in a cohort of medical intensive care patients and to compare it with that of other known biomarkers and physiological scores. Methods： Blood samples of 51 consecutive critically ill patients admitted to the intensive care unit and 53 age-matched healthy control people were evaluated in this prospective study. The prognostic value ofpro-ANP and pro-ADM levels was compared with that of acute physiology and chronic health evaluation （APACHE） II scores and various biomarkers such as C-reactive protein, interleukin-6 and procalcitonin. Pro-ANP and pro-ADM were detected by a new sandwich immunoassay. Results： On admission, 25 patients had systemic inflammatory response syndrome （SIRS）, 12 sepsis, 9 severe sepsis and 5 septic shock. At that time, the median levels （ng/ml） of pro-ANP and pro-ADM were 87.22 and 0.34 respectively in patients with SIRS, 1533.30 and 2.23 in those with sepsis, 1098.73 and 4.57 in those with severe sepsis, and 1933.94 and 8.21 in those with septic shock. With the increasing severity of disease, the levels of pro- ANP and pro-ADM were gradually increased. On admission, the circulating levels ofpro-ANP and pro-ADM in patients with sepsis, severe sepsis, or septic shock were significantly higher in non-survivors than in survivors （P〈0.05）. In a receiver operating characteristic curve analysis for the survival of patients with sepsis, the areas under the curve （AUCs） for pro-ANP and pro-ADM were 0.89 and 0.87 respectively, which was similar to the AUCs for procalcitonin and APACHE II scores. Conclusion： Pro-ANP and pro-ADM are valuable biomarkers for prediction of severity of septic patients.