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IntroductionCoronary artery calcium (CAC) scans contain useful information beyond the Agatston CAC score that is not currently reported. We recently reported that artificial intelligence (AI)-enabled cardiac chambers volumetry in CAC scans (AI-CAC™) predicted incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis (MESA). In this study, we investigated the performance of AI-CAC cardiac chambers for prediction of incident heart failure (HF).MethodsWe applied AI-CAC to 5750 CAC scans of asymptomatic individuals (52% female, White 40%, Black 26%, Hispanic 22% Chinese 12%) free of known cardiovascular disease at the MESA baseline examination (2000-2002). We used the 15-year outcomes data and compared the time-dependent area under the curve (AUC) of AI-CAC volumetry versus NT-proBNP, Agatston score, and 9 known clinical risk factors (age, gender, diabetes, current smoking, hypertension medication, systolic and diastolic blood pressure, LDL, HDL for predicting incident HF over 15 years.ResultsOver 15 years of follow-up, 256 HF events accrued. The time-dependent AUC [95% CI] at 15 years for predicting HF with AI-CAC all chambers volumetry (0.86 [0.82,0.91]) was significantly higher than NT-proBNP (0.74 [0.69, 0.77]) and Agatston score (0.71 [0.68, 0.78]) (p ​

Background Cardiac injury caused by iron overload is the leading cause of mortality and morbidity in patients with beta-thalassemia, owing to frequent blood transfusion, increased iron overload, and blood hemolysis. Objective This research aimed to assess several novel cardiac biomarkers in the blood samples of children and adult patients with beta-thalassemia major (βTM), along with their respective control groups. These biomarkers included endothelin 1 (ET-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), atrial natriuretic peptide (ANP), growth differentiation factor-15 (GDF-15), and renalase (RNLS). Methods This case-control study was done on 46 patients with βTM (23 children <18 years, and 23 adults ≥18 years) from the Genetic Hematology Center in Thi-Qar province, Iraq, and 42 comparable controls in 2 groups (21 for each group) in the period from February to April 2023. Results Levels of ET-1, NT-proBNP, ANP, GDF-15, RNLS, and ferritin were higher in the children and adults with βTM than in the control subjects. Conclusion Elevations of the novel cardiac biomarkers ET-1, NT-proBNP, ANP, GDF-15, and RNLS in the sera of children and adult patients with βTM when compared with comparable control subjects confirm that the majority of patients with βTM are at risk of cardiac and cardiovascular complications even when there are no obvious symptoms, especially in children, which gives suitable predictive biomarkers. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) increases morbidity and mortality. Our study aimed to investigate the role of baseline N-terminal pro B-type natriuretic peptide (NT-proBNP) as a predictor of AKI following TAVI. All consecutive TAVI patients were included in the analysis, except patients with dialysis and those with a GFR < 15 ml/min/1.73 m2 at baseline. Rates of AKI after TAVI were assessed according to the updated valve academic research consortium definitions using AKIN classification in three stages. NT-proBNP was measured at baseline. One-year mortality rates were assessed. We included 1973 patients treated with TAVI between January 2006 and December 2016. Median [IQR] age was 81.0 [77.0;84.0] years, the STS score was 6.2 [3.9;9.0], and the logEuroScore was 14.5 [9.0;23.0]. 30-day and one-year mortality was 5.1 % and 16.1 % for all patients, respectively. Multivariate analysis revealed that patients with NT-proBNP levels higher than two times above the upper level of normal (ULN) had an increased risk for AKI after TAVI compared to patients with NT-proBNP levels < 2× ULN (OR 1.40 [1.03–1.91]). Routine assessment of baseline NT-proBNP levels might be an additional tool to identify patients at increased risk for AKI after TAVI. • Acute kidney injury is associated with adverse outcomes in TAVI patients. • Baseline NT-proBNP is an independent predictor of AKI after TAVI. • Early identification of patients at high risk for AKI is crucial. • High-risk patients may benefit from further reducing the periprocedural amount of CM. [ABSTRACT FROM AUTHOR]

Natriuretic peptides (NP) play an essential role in heart failure (HF) regulation, and their measurement has improved diagnostic and prognostic accuracy. Clinical symptoms and objective measurements, such as NP levels, should be included in the HF definition to render it more reliable and consistent among observers, hospitals, and healthcare systems. BNP and NT-proBNP are reasonable surrogates for cardiac disease, and their measurement is critical to early diagnosis and risk stratification of HF patients. NPs should be measured in all patients presenting with dyspnea or other symptoms suggestive of HF to facilitate early diagnosis and risk stratification. Both BNP and NT-proBNP are currently used for guided HF management and display comparable diagnostic and prognostic accuracy. Standardized cutoffs for each NP assay are essential for data comparison. The value of NP testing is recognized at various levels, including patient empowerment and education, analytical and operational issues, clinical HF management, and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) significantly increases morbidity and mortality following cardiac surgery, especially in patients with pre-existing renal impairments. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of cardiac stress and dysfunction, conditions often exacerbated during cardiac surgery and prevalent in chronic kidney disease (CKD) patients. Elevated NT-proBNP levels can indicate underlying cardiac strain, hemodynamic instability and volume overload. This study evaluated the association between perioperative changes in NT-proBNP levels and the incidence of AKI in this particular patient group. Methods: This retrospective study involved patients with impaired renal function (eGFR 15–60 ml/min/1.73 m²) who underwent cardiac surgery from July to December 2022. It analyzed the association between the ratio of preoperative and ICU admittance post-surgery NT-proBNP levels and the development of AKI and AKI stage 2–3, based on KDIGO criteria, using multivariate logistic regression models. Restricted cubic spline analysis assessed non-linear associations between NT-proBNP and endpoints. Subgroup analysis was performed to assess the heterogeneity of the association between NT-proBNP and endpoints in subgroups. Results: Among the 199 participants, 116 developed postoperative AKI and 16 required renal replacement therapy. Patients with AKI showed significantly higher postoperative NT-proBNP levels compared to those without AKI. Decreased baseline eGFR and increased post/preoperative NT-proBNP ratios were associated with higher AKI risk. Specifically, the highest quantile post/preoperative NT-proBNP ratio indicated an approximately seven-fold increase in AKI risk and a ninefold increase in AKI stage 2–3 risk compared to the lowest quantile. The area under the receiver operating characteristic curve for predicting AKI and AKI stage 2–3 using NT-proBNP were 0.63 and 0.71, respectively, demonstrating moderate accuracy. Subgroup analysis demonstrated that the positive association between endpoints and logarithmic transformed post/preoperative NT-proBNP levels was consistently robust in subgroup analyses stratified by age, sex, surgery, CPB application, hypertension, diabetes status and fluid balance. Conclusion: Perioperative NT-proBNP level changes are predictive of postoperative AKI in patients with pre-existing renal deficiencies undergoing cardiac surgery, aiding in risk assessment and patient management. [ABSTRACT FROM AUTHOR]

Background: We evaluated the prevalence of "heart stress" (HS) based on NT-proBNP cut-points proposed by the 2023 Consensus of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in asymptomatic patients with T2DM and hypertension or high-normal blood pressure (BP) eligible for SGLT2 inhibitors (SGLT2i) and/or GLP-1 receptor agonists (GLP1-RA), drugs with proven benefits on reducing the incidence of HF, hospitalizations, cardiovascular events and mortality. Methods: A cross-sectional multicentric study was conducted on 192 consecutive outpatients, aged ≥ 55 years, with hypertension or high-normal BP, referred to three diabetology units. NT-proBNP was collected before starting new anti-diabetic therapy. Patients with known HF were excluded, and participants were classified based on the age-adjusted NT-proBNP cut-points. Results: Mean age: 70.3 ± 7.8 years (67.5% males). Patients with obesity (BMI ≥ 30 Kg/m2): 63.8%. Median NT-proBNP: 96.0 (38.8–213.0) pg/mL. Prevalence of chronic kidney disease (CKD, eGFR < 60 mL/min/1.73m2): 32.1%. Mean arterial BP: 138.5/77.0 ± 15.8/9.9 mmHg. The NT-proBNP values, according to the proposed age-adjusted cut-points, classified 28.6% of patients as "HS likely" (organize elective echocardiography and specialist evaluation), 43.2% as "HS not likely" (a grey area, repeat NT-proBNP at six months) and 28.2% as "very unlikely HS" (repeat NT-proBNP at one year). The presence of CKD and the number of anti-hypertensive drugs, but not glycemic parameters, were independently associated with HS. Conclusions: According to NT-proBNP, over a quarter of T2DM patients with hypertension/high-normal BP, among those eligible for SGLT2i and/or GLP1-RA, were already at risk of cardiac damage, even subclinical. Most would receive an indication to echocardiogram and be referred to a specialist, allowing the early implementation of effective strategies to prevent or delay the progression to advanced stages of cardiac disease and overt HF. [ABSTRACT FROM AUTHOR]

Background: Individuals of South Asian origin have a greater risk of cardiovascular disease after gestational diabetes mellitus (GDM) than European individuals. B-type natriuretic peptide (BNP) and the amino-terminal fragment of its prohormone (NT-proBNP) are commonly used for heart failure screening and diagnosis, but biologically BNP exerts several beneficial cardiovascular effects primarily by counteracting the renin-angiotensin-aldosterone-system. We asked whether ethnic differences in circulating NT-proBNP levels could be explained by the differences in cardiometabolic and inflammatory risk markers? Methods: We examined 162 South Asian and 107 Nordic women in Norway 1–3 years after GDM with a clinical examination, fasting blood samples and an oral glucose tolerance test. We measured the levels of NT-proBNP, high-sensitivity cardiac troponin T, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), leptin, adiponectin and markers of insulin sensitivity, such as the Matsuda insulin sensitivity index (ISI). Finally, we tried to identify which independent covariate best mediated the ethnic differences in NT-proBNP. Results: The mean (SD) age was 35.3 (4.5) years, BMI 29.1 (6.0) kg/m2, waist-height ratio 0.60 (0.08) and 164 women (61%) had prediabetes/diabetes. Notably, South Asian women had lower levels of NT-proBNP than Nordic women in both the normoglycemic and prediabetes/diabetes groups (median (IQR) 26 (15–38) vs. 42 (22–66) ng/L, p < 0.001). Higher NT-proBNP levels were associated with greater insulin sensitivity in both South Asian and Nordic women (p = 0.005 and p < 0.001). South Asian women had higher levels of hsCRP (median (IQR) 2.2 (1.1–4.4) vs. 1.2 (0.3–4.2) mg/L), IL-6 (2.3 (1.5–3.2) vs. 1.5 (1.5–2.5) pg/mL), leptin (1647 (1176–2480) vs. 1223 (876–2313) pmol/L), and lower adiponectin levels (7.2 (5.3–9.3) vs. 10.0 (7.2–13.5) mg/L) and Matsuda ISI (2.4 (1.7–3.7) vs. 4.2 (2.9–6.1), pall<0.01) than Nordic women. Even after adjusting for these differences, higher NT-proBNP levels remained associated with insulin sensitivity (22% higher NT-proBNP per SD Matsuda ISI, p = 0.015). Insulin sensitivity and adiponectin mediated 53% and 41% of the ethnic difference in NT-proBNP. Conclusions: NT-proBNP levels are lower in South Asian than in Nordic women after GDM. Lower NT-proBNP levels correlate with impaired insulin sensitivity. Lower NT-proBNP levels in South Asian women could, therefore, be attributed to impaired insulin sensitivity rather than total body fat. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the guideline recommended diagnostic tools NT-proBNP and NYHA classification, with a focus on sex-specific differences. Background: Patients with Type 2 Diabetes (T2D) face a heart failure (HF) risk up to four times higher than those without T2D, particularly affecting women more than twice as much as men. Despite distinct pathophysiological differences between men and women, there are currently no sex-specific recommendations for the diagnostic algorithm of HF in diabetic patients. Methods: A total of 2083 patients with T2D were enrolled, and the primary endpoint was heart failure during hospitalization within a 5-year timeframe. The secondary endpoint was all-cause death. Results: In female patients, frequency of HF diagnosis prior to or during hospitalization and mortality did not differ significantly between NYHA II and III, in contrast to male patients. Additionally, there was no notable difference in mean NT-proBNP levels between NYHA stage II and III only in female patients. The multivariable regression analysis highlighted NYHA classification not to be a predictor of NT-proBNP levels in female but solely in male patients. On multivariable Cox regression NYHA score was also no significant risk factor for occurence of HF in female patients. Furthermore, there was no significant disparity in mortality between men with NT-proBNP levels between 125 and 400 pg/ml and those below 125 pg/ml, whereas in women mortality was significantly higher in the group with NT-proBNP levels between 125 and 400 pg/ml than below 125 pg/ml. Conclusion: These findings suggest that NYHA classification may not be the most suitable tool for assessing the diagnosis of HF in female patients with T2D. Moreover, the need for consideration of a more symptom-independent screening for HF in female patients with T2D and re-evaluation of current guidelines especially regarding sex-specific aspects is highlighted. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) and acute kidney injury (AKI) after liver transplantation (LT), to clarify the influencing factors for AKI after liver transplantation, and to provide diagnostic reference indicators for the early prevention of AKI after LT. Methods A retrospective analysis was performed for the medical records of the adult patients who underwent LT in The First Hospital of Jilin University from September 13，2020 to June 30，2022, and according to the presence or absence of AKI after LT, the patients were divided into AKI group and non-AKI group. The propensity score matching (PSM) method was used to match the basic information of the two groups at a ratio of 1∶4. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The multivariate Logistic regression analysis was used to investigate the independent risk factors for AKI after LT. Results A total of 144 patients were included in this study, among whom 22 (15.3%) developed AKI after surgery and 122 (84.7%) did not develop postoperative AKI. A total of 93 patients were included after PSM, with 19 patients in the AKI group and 74 patients in the nonAKI group. The multivariate Logistic regression analysis showed that preoperative NT-proBNP (odds ratio ［OR］=7.692，95% confidence interval ［CI］：1.473—40.159，P=0.016), preoperative fibrinogen level (OR=5.520，95%CI：1.160—26.267，P= 0.032), time of operation (OR=15.802，95%CI：2.418—103.268，P=0.004), and intraoperative blood loss (OR=13.246，95%CI： 2.291—76.594，P=0.004) were independent risk factors for AKI after LT. Conclusion Preoperative NT-proBNP level may be used as a predictive factor for AKI after LT and can provide a certain reference for establishing a risk predictive model for AKI after LT. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To evaluate the association of sarcopenia and low appendicular skeletal muscle mass with B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) levels in patients with heart failure. Findings: Sarcopenia was associated with significantly greater levels of BNP (MD: 87.76, 95% CI 20.74 – 154.78, I2 = 61%, P = 0.01) and NT-proBNP (MD: 947.45, 95% CI 98.97 – 1795.93, I2 = 35%, P = 0.03). Likewise, low appendicular skeletal muscle mass was linked to higher levels of BNP (MD: 118.95, 95% CI 46.91 – 191.00, I2 = 93%, P < 0.01) and NT-proBNP (MD: 672.01, 95% CI 383.72 – 960.30, I2 = 2%, P < 0.01). Message: Research is needed to determine whether sarcopenia may be a contributor to dysregulated plasma concentrations of natriuretic peptides. Aims: Sarcopenia is linked to impaired physical function and exercise tolerance. The aim of this systematic review and meta-analysis was to examine the association of sarcopenia and low appendicular skeletal muscle (ASM) with biomarkers of cardiac function, B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP), in patients with heart failure (HF). Methods and results: From inception until May 2023, a systematic literature search of observational studies was undertaken utilizing the PubMed, Web of Science, Scopus, and Cochrane Library databases. A meta-analysis employing a random-effects model was used to compute the pooled effects (CRD42023418465). Overall, 16 studies were included in this systematic review and meta-analysis. Our main analysis showed that sarcopenia in HF was linked to significantly higher levels of BNP (MD: 87.76, 95% CI 20.74–154.78, I2 = 61%, P = 0.01) and NT-proBNP (MD: 947.45, 95% CI 98.97–1795.93, I2 = 35%, P = 0.03). Similarly, low ASM was associated with significantly higher levels of BNP (MD: 118.95, 95% CI 46.91–191.00, I2 = 93%, P < 0.01) and NT-proBNP (MD: 672.01, 95% CI 383.72–960.30, I2 = 2%, P < 0.01). The quality of the included cohort studies was considered moderate, using the binary AXIS checklist and the Cochrane Tool to Assess the Risk of Bias in Cohort Studies. Conclusions: In patients with HF, sarcopenia and reduced ASM are associated with considerably higher plasma levels of BNP and NT-proBNP. Future research is required to investigate whether sarcopenia may express dysregulated biomarkers of cardiac function. [ABSTRACT FROM AUTHOR]

Background: The study evaluated the performance of the Mindray N-terminal pro-B-type natriuretic peptide (NT-proBNP) in a healthy population in China, focusing on creating a reference range for future clinical applications adjusted according to different demographics. Methods: The study measured NT-proBNP in 2277 healthy individuals. We analyzed age and sex-stratified data, performed precision, accuracy, linearitcvy, and detection limit studies, and evaluated method comparison and consistency between Roche and Mindray assays on 724 serum samples. We used Excel 2010, Medcalc, and GraphPad Prism 9. Results: In males, the 97.5th centile NT-proBNP concentration at age < 45, 45 to 54, 55 to 64, 65 to 74 and ≧ 75 were 89.4 ng/L, 126 ng/L, 206 ng/L, 386 ng/L and 522 ng/L, respectively. In females, the concentration of NT-proBNP at the same age was 132 ng/L, 229 ng/L, 262 ng/L, 297 ng/L and 807 ng/L, respectively. The repeatability precision coefficient of variation (CV%) for NT-proBNP was between 0.86 and 1.65 in analytical performance. In contrast, the reproducibility precision (CV%) for NT-proBNP was between 1.52 and 3.22, respectively. The study found a bias of accuracy of 3.73% in low-value samples (concentration: 148.69) and 7.31% in high-value samples (concentration: 1939.08). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 125 ng/L were 96.6%, 92.3%, 84.2%, and 98.5%, respectively. In contrast, those of 300 ng/L were 94.0%, 98.2%, 95.7% and 97.5%, respectively. Conclusions: The Mindray NT-proBNP assay showed increased levels in both males and females with age, with higher levels in women. It performs well and aligns with manufacturer specifications. We recommend adjusting cutoff values based on demographic factors. [ABSTRACT FROM AUTHOR]

Aim: To create and validate a prediction model to identify patients with type 2 diabetes (T2D) at high risk of new‐onset heart failure (HF), including those treated with a sodium‐glucose cotransporter‐2 (SGLT2) inhibitor. Methods: A prediction model was developed from the Aliskiren Trial in Type 2 Diabetes Using Cardiorenal Endpoints (ALTITUDE), a trial in T2D patients with albuminuria or cardiovascular disease. We included 5081 patients with baseline N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) measurement and no history of HF. The model was developed using Cox regression and validated externally in the placebo arm of the Canagliflozin Cardiovascular Assessment Study (CANVAS), which included 996 participants with T2D and established cardiovascular disease or high cardiovascular risk, and in patients treated with canagliflozin. Results: ALTITUDE participants (mean age 64 ± 9.8 years) had a median serum NT‐proBNP level of 157 (25th–75th percentile 70–359) pg/mL. Higher NT‐proBNP level, troponin T (TnT) level and body mass index (BMI) emerged as significant and independent predictors of new‐onset HF in both cohorts. The model further contained urinary albumin‐to‐creatinine ratio, glycated haemoglobin, age, haematocrit, and use of calcium channel blockers. A prediction model including these variables had a C‐statistic of 0.828 (95% confidence interval [CI] 0.801–0.855) in ALTITUDE and 0.800 (95% CI 0.720–0.880) in CANVAS. The C‐statistic of this model increased to 0.847 (95% CI 0.792–0.902) in patients after 1 year of canagliflozin treatment. Conclusion: In patients with T2D, higher NT‐proBNP level, TnT level and BMI are independent and externally validated predictors of new‐onset HF, including patients using an SGLT2 inhibitor. This newly developed model may identify patients at high risk of new‐onset HF, contributing to early recognition and possibly prevention. [ABSTRACT FROM AUTHOR]

Background- Primary Hyperparathyroidism (PHPT) has been associated with increased cardiovascular morbidity and early death. Data on the extent and clinical significance of cardiovascular abnormalities in primary hyperparathyroidism (PHPT) are conflicting. The main objective of this study was to evaluate the cardiac function in patients with PHPT without other known risk factors and to analyze the effect of parathyroidectomy. Methodology- In a Prospective Observational Cohort design, sixteen patients with Primary Hyperparathyroidism underwent Two-dimensional echocardiography, Electrocardiography, serum N-terminal pro-brain natriuretic peptide (NT-proBNP, a myocardial damage marker), before and 3 months after successful parathyroidectomy. Result- We observed significant improvement in Left ventricular ejection fraction (p = 0.010) in patients undergoing parathyroid surgery after 3 months postoperatively. There is significant reduction in LVMI (p=0.044) & posterior wall thickness (p=0.007), which are indicators of left ventricular hypertrophy after 3 months of surgery. Conclusion- Patients with PHPT who are symptomatic exhibit significant cardiovascular dysfunction, which improves three months following successful parathyroidectomy. As a part of screening, we should consider routine cardiovascular evaluation in all symptomatic patients of PHPT. Symptomatic PHPT patients should undergo early curative surgery for the reversal of the cardiovascular dysfunction and in asymptomatic PHPT patients also early surgery is recommended for the prevention of end organ damage. [ABSTRACT FROM AUTHOR]

The cardiac biomarkers high sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are utilised in paediatric healthcare for the diagnosis and prognostic assessment of many conditions including myocarditis, congenital heart disease, multisystem inflammatory syndrome in children (MIS-C) and heart failure. However, the standardised age-related reference intervals, 99th percentile cut-offs and clinical guidelines are not available, making the interpretation of these biomarkers challenging. This study aimed to generate normative data in a paediatric cohort for the Siemens Atellica® IM 1300 analyser. Residual plasma samples were collected from children aged up to 17 years attending primary care and out-patient settings and with no apparent evidence of cardiac dysfunction, renal dysfunction or other confounders. Reference intervals were generated using the 2.5th–97.5th percentiles, and 99th percentile cut-offs determined according to CLSI EP28-A3c. Statistical analysis revealed that partitioning was not required for gender for either biomarker. The reference interval for hs-cTnI for children aged one month to 16 years (n=292, 146 females and 146 males) was <14 ng/L with a 99th percentile cut-off of 19 ng/L. The reference interval for NT-proBNP for children aged one month up to one year was <714 ng/L (n=14) and for children aged 1–16 years (n=339) was <295 ng/L. This is the first paediatric reference interval data generated on the Siemens Atellica® solution. These reference intervals and 99th percentiles will inform clinical decisions in the paediatric cardiology setting. [ABSTRACT FROM AUTHOR]

Coronary artery calcium (CAC) scans contain actionable information beyond CAC scores that is not currently reported. We have applied artificial intelligence-enabled automated cardiac chambers volumetry to CAC scans (AI-CACTM) to 5535 asymptomatic individuals (52.2% women, ages 45–84) that were previously obtained for CAC scoring in the baseline examination (2000–2002) of the Multi-Ethnic Study of Atherosclerosis (MESA). AI-CAC took on average 21 ​s per CAC scan. We used the 5-year outcomes data for incident atrial fibrillation (AF) and assessed discrimination using the time-dependent area under the curve (AUC) of AI-CAC LA volume with known predictors of AF, the CHARGE-AF Risk Score and NT-proBNP. The mean follow-up time to an AF event was 2.9 ​± ​1.4 years. At 1,2,3,4, and 5 years follow-up 36, 77, 123, 182, and 236 cases of AF were identified, respectively. The AUC for AI-CAC LA volume was significantly higher than CHARGE-AF for Years 1, 2, and 3 (0.83 vs. 0.74, 0.84 vs. 0.80, and 0.81 vs. 0.78, respectively, all p ​< ​0.05), but similar for Years 4 and 5, and significantly higher than NT-proBNP at Years 1–5 (all p ​< ​0.01), but not for combined CHARGE-AF and NT-proBNP at any year. AI-CAC LA significantly improved the continuous Net Reclassification Index for prediction of AF over years 1–5 when added to CHARGE-AF Risk Score (0.60, 0.28, 0.32, 0.19, 0.24), and NT-proBNP (0.68, 0.44, 0.42, 0.30, 0.37) (all p ​< ​0.01). AI-CAC LA volume enabled prediction of AF as early as one year and significantly improved on risk classification of CHARGE-AF Risk Score and NT-proBNP. [ABSTRACT FROM AUTHOR]

Background: European Society of Cardiology (ESC) guidelines recommend measuring natriuretic peptides (BNP or NT-proBNP) in patients with suspected heart failure (HF) as a first-line tool. HF should be ruled-out if concentrations of NT-proBNP are below 300 ng/L and 125 ng/L for acute HF and chronic HF, respectively. Methods: Patients with suspected HF referred for transthoracic echocardiography (TTE) were enrolled; NT-proBNP concentrations were obtained from medical charts (measurement < 48 hours) or prospectively measured on the day of TTE. Results: Out of 109 patients, NT-proBNP was measured by the referring department before TTE in 40 patients (36.7%), and 37.5% of these patients had NT-proBNP concentration below the rule-out threshold. NT-proBNP was measured in additional 38 patients on the day of TTE. Overall, 38.5% of the patients had a NT-proBNP concentration below the threshold value. Conclusions: Natriuretic peptides are not routinely measured in patients with suspected HF; systematic measurement would reduce unnecessary TTE by at least 38.5% [ABSTRACT FROM AUTHOR]

Abstract N-terminal pro-Brain-type natriuretic peptide (NT-proBNP) has a predictive value of cardiovascular disease (CVD). Pro-inflammatory diet has been proven to be related to CVD. Our study investigated whether the association between NT-proBNP and mortality differed among general U.S. adults with different dietary inflammatory index (DII) scores. This study utilized the National Health and Nutrition Examination Surveys (NHANES) database from 1999 to 2004. Non-pregnant U.S. adults aged ≥ 20 years and without CVD were included. Cox regression model and restricted cubic splines were used to investigate the associations between NT-proBNP, DII, and mortality. A total of 9788 adults were included, and 2386 all-cause deaths with 668 CVD deaths occurred over 17.08 years of follow-up. NT-proBNP was positively associated with DII scores (P

Abstract Background Acute kidney injury (AKI) significantly increases morbidity and mortality following cardiac surgery, especially in patients with pre-existing renal impairments. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of cardiac stress and dysfunction, conditions often exacerbated during cardiac surgery and prevalent in chronic kidney disease (CKD) patients. Elevated NT-proBNP levels can indicate underlying cardiac strain, hemodynamic instability and volume overload. This study evaluated the association between perioperative changes in NT-proBNP levels and the incidence of AKI in this particular patient group. Methods This retrospective study involved patients with impaired renal function (eGFR 15–60 ml/min/1.73 m²) who underwent cardiac surgery from July to December 2022. It analyzed the association between the ratio of preoperative and ICU admittance post-surgery NT-proBNP levels and the development of AKI and AKI stage 2–3, based on KDIGO criteria, using multivariate logistic regression models. Restricted cubic spline analysis assessed non-linear associations between NT-proBNP and endpoints. Subgroup analysis was performed to assess the heterogeneity of the association between NT-proBNP and endpoints in subgroups. Results Among the 199 participants, 116 developed postoperative AKI and 16 required renal replacement therapy. Patients with AKI showed significantly higher postoperative NT-proBNP levels compared to those without AKI. Decreased baseline eGFR and increased post/preoperative NT-proBNP ratios were associated with higher AKI risk. Specifically, the highest quantile post/preoperative NT-proBNP ratio indicated an approximately seven-fold increase in AKI risk and a ninefold increase in AKI stage 2–3 risk compared to the lowest quantile. The area under the receiver operating characteristic curve for predicting AKI and AKI stage 2–3 using NT-proBNP were 0.63 and 0.71, respectively, demonstrating moderate accuracy. Subgroup analysis demonstrated that the positive association between endpoints and logarithmic transformed post/preoperative NT-proBNP levels was consistently robust in subgroup analyses stratified by age, sex, surgery, CPB application, hypertension, diabetes status and fluid balance. Conclusion Perioperative NT-proBNP level changes are predictive of postoperative AKI in patients with pre-existing renal deficiencies undergoing cardiac surgery, aiding in risk assessment and patient management.

Abstract Background We evaluated the prevalence of “heart stress” (HS) based on NT-proBNP cut-points proposed by the 2023 Consensus of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in asymptomatic patients with T2DM and hypertension or high-normal blood pressure (BP) eligible for SGLT2 inhibitors (SGLT2i) and/or GLP-1 receptor agonists (GLP1-RA), drugs with proven benefits on reducing the incidence of HF, hospitalizations, cardiovascular events and mortality. Methods A cross-sectional multicentric study was conducted on 192 consecutive outpatients, aged ≥ 55 years, with hypertension or high-normal BP, referred to three diabetology units. NT-proBNP was collected before starting new anti-diabetic therapy. Patients with known HF were excluded, and participants were classified based on the age-adjusted NT-proBNP cut-points. Results Mean age: 70.3 ± 7.8 years (67.5% males). Patients with obesity (BMI ≥ 30 Kg/m2): 63.8%. Median NT-proBNP: 96.0 (38.8–213.0) pg/mL. Prevalence of chronic kidney disease (CKD, eGFR

Abstract Objectives This study aimed to assess the guideline recommended diagnostic tools NT-proBNP and NYHA classification, with a focus on sex-specific differences. Background Patients with Type 2 Diabetes (T2D) face a heart failure (HF) risk up to four times higher than those without T2D, particularly affecting women more than twice as much as men. Despite distinct pathophysiological differences between men and women, there are currently no sex-specific recommendations for the diagnostic algorithm of HF in diabetic patients. Methods A total of 2083 patients with T2D were enrolled, and the primary endpoint was heart failure during hospitalization within a 5-year timeframe. The secondary endpoint was all-cause death. Results In female patients, frequency of HF diagnosis prior to or during hospitalization and mortality did not differ significantly between NYHA II and III, in contrast to male patients. Additionally, there was no notable difference in mean NT-proBNP levels between NYHA stage II and III only in female patients. The multivariable regression analysis highlighted NYHA classification not to be a predictor of NT-proBNP levels in female but solely in male patients. On multivariable Cox regression NYHA score was also no significant risk factor for occurence of HF in female patients. Furthermore, there was no significant disparity in mortality between men with NT-proBNP levels between 125 and 400 pg/ml and those below 125 pg/ml, whereas in women mortality was significantly higher in the group with NT-proBNP levels between 125 and 400 pg/ml than below 125 pg/ml. Conclusion These findings suggest that NYHA classification may not be the most suitable tool for assessing the diagnosis of HF in female patients with T2D. Moreover, the need for consideration of a more symptom-independent screening for HF in female patients with T2D and re-evaluation of current guidelines especially regarding sex-specific aspects is highlighted.

Abstract Background Individuals of South Asian origin have a greater risk of cardiovascular disease after gestational diabetes mellitus (GDM) than European individuals. B-type natriuretic peptide (BNP) and the amino-terminal fragment of its prohormone (NT-proBNP) are commonly used for heart failure screening and diagnosis, but biologically BNP exerts several beneficial cardiovascular effects primarily by counteracting the renin-angiotensin-aldosterone-system. We asked whether ethnic differences in circulating NT-proBNP levels could be explained by the differences in cardiometabolic and inflammatory risk markers? Methods We examined 162 South Asian and 107 Nordic women in Norway 1–3 years after GDM with a clinical examination, fasting blood samples and an oral glucose tolerance test. We measured the levels of NT-proBNP, high-sensitivity cardiac troponin T, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), leptin, adiponectin and markers of insulin sensitivity, such as the Matsuda insulin sensitivity index (ISI). Finally, we tried to identify which independent covariate best mediated the ethnic differences in NT-proBNP. Results The mean (SD) age was 35.3 (4.5) years, BMI 29.1 (6.0) kg/m2, waist-height ratio 0.60 (0.08) and 164 women (61%) had prediabetes/diabetes. Notably, South Asian women had lower levels of NT-proBNP than Nordic women in both the normoglycemic and prediabetes/diabetes groups (median (IQR) 26 (15–38) vs. 42 (22–66) ng/L, p

Abstract Background The study evaluated the performance of the Mindray N-terminal pro-B-type natriuretic peptide (NT-proBNP) in a healthy population in China, focusing on creating a reference range for future clinical applications adjusted according to different demographics. Methods The study measured NT-proBNP in 2277 healthy individuals. We analyzed age and sex-stratified data, performed precision, accuracy, linearitcvy, and detection limit studies, and evaluated method comparison and consistency between Roche and Mindray assays on 724 serum samples. We used Excel 2010, Medcalc, and GraphPad Prism 9. Results In males, the 97.5th centile NT-proBNP concentration at age

Background: Despite comprehensive study, the aetiology of stroke is not identified in 35% of cases. Aims: We conducted a study to assess the diagnostic capacity of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the identification of ischaemic stroke of cardioembolic origin. The secondary purpose of the study was to evaluate the prognostic value of NT-proBNP for predicting 90-day all-cause mortality. Methods: We designed a prospective observational study including patients hospitalised due to stroke between March 2019 and March 2020. Blood samples were collected on admission to the emergency department and serum NT-proBNP levels were determined. Statistical analysis was performed using a bivariate logistic regression model and receiver operating characteristic (ROC) and Kaplan–Meier curves. Statistical significance was established at p 499 pg/mL was the optimum value for diagnosing cardioembolic ischaemic stroke (sensitivity, 82%; specificity, 80%). Moreover, plasma NT-proBNP levels > 499 pg/mL were independently associated with cardioembolic stroke (OR: 9.881; p = .001). Finally, NT-proBNP > 1500 pg/mL was useful for predicting 90-day mortality (sensitivity, 70%; specificity, 93%). Conclusions: NT-proBNP was independently associated with cardioembolic stroke and should be quantified in blood tests within 24 h of stroke onset. High plasma levels (>499 pg/mL) may indicate an underlying cardioembolic cause, which should be further studied, while NT-proBNP >1500 pg/mL was associated with increased 90-day mortality. Resumen: Introducción: A pesar de un completo y exhaustivo estudio, la etiología de un 35% de los ictus isquémicos es desconocida. Objetivos: Evaluar la capacidad de diagnóstico del NT-proBNP en la identificación del ictus isquémico de origen cardioembólico. El objetivo secundario fue evaluar el valor pronóstico del NT-proBNP como predictor de mortalidad de cualquier causa tras 90 días del ictus. Métodos: Diseñamos un estudio observacional prospectivo, incluyendo pacientes hospitalizados por ictus. El periodo de reclutamiento fue de marzo de 2019 a marzo de 2020. Se obtuvieron muestras de sangre a su admisión en Urgencias y se midieron los niveles plasmáticos de NT-proBNP. El análisis estadístico fue realizado mediante un modelo bivariado de regresión logística, curva de la característica operativa del receptor (curvas ROC) y curvas Kaplan-Meier. Se consideraron significativas diferencias con p < 0,05. Resultados: Fueron incluidos 207 pacientes con un primer episodio de ictus isquémico agudo. Los niveles de NT-proBNP fueron significativamente mayores (p < 0,001) en el grupo de ictus isquémico cardioembólico (2.069 ± 488,5). Las curvas ROC mostraron que un NT-proBNP > 499 pg/mL es el valor óptimo para el diagnóstico de ictus isquémico cardioembólico (sensibilidad 82%, especificidad 80%). Además, los niveles plasmáticos de NT-proBNP > 499 pg/mL estaban asociados de forma independiente con el ictus isquémico cardioembólico (OR = 9.881, p = 0,001). Finalmente, un valor de NT-proBNP > 1.500 pg/mL fue útil para predecir la mortalidad de cualquier causa 90 días tras el ictus isquémico (sensibilidad = 70%, especificidad = 93%). Conclusiones: El valor de NT-proBNP estaba asociado independientemente al ictus isquémico de origen cardioembólico y debería ser considerado su análisis en las primeras 24 h desde el inicio del ictus. Niveles elevados (NT-proBNP > 499 pg/mL) pueden indicar un origen cardioembólico subyacente, el cual debería ser estudiado con mayor detalle, mientras que niveles de NT-proBNP > 1.500 pg/mL se asociaron con un incremento de la mortalidad a los 90 días del ictus.

Lin Sun,1,2,&ast; Xu Zhao,1 Yunting Guo,1,&ast; Xiaomin Hou,3– 5 Jieru Li,6 Xiaoxia Ren,7 Lin Dong,1 Ruifeng Liang,1 Jisheng Nie,1 Yiwei Shi,2 Xiaojiang Qin1,2,4,5,8 1School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 3Department of Pharmacology, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 4China Key Laboratory of Cellular Physiology, Shanxi Medical University, Taiyuan, Shanxi, China; 5Environmental Exposures Vascular Disease Institute, Taiyuan, Shanxi, People’s Republic of China; 6Department of Foreign Languages, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 7Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 8Key Laboratory of Coal Environmental Pathogenicity and Prevention, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaojiang Qin, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, Shanxi, 030001, People’s Republic of China, Tel +86-18735379826, Email sph@sxmu.edu.cn Yiwei Shi, Department of Respiratory and Critical Care Medicine, The First Hospital of Shanxi Medical University, 85 Jiefang South Road, Taiyuan, Shanxi, 030001, People’s Republic of China, Tel +86-13835193132, Email chinasyw225@163.comPurpose: Smoking is a major risk factor for the group 3 PH. NT-proBNP is a biomarker for risk stratification in PH. This study aims to investigate the effects of smoking status and smoking index (SI) on group 3 PH and to evaluate the value of SI and SI combined with NT-proBNP in early diagnosis and prediction of disease severity.Patients and Methods: Four hundred patients with group 3 PH at the First Hospital of Shanxi Medical University between January 2020 and December 2021 were enrolled and divided into two groups: mild (30 mmHg ≤ pulmonary artery systolic pressure (PASP)≤ 50 mmHg) and non-mild (PASP > 50 mmHg). The effect of smoking on group 3 PH was analyzed using univariate analysis, and logistic analysis was conducted to evaluate the risk of group 3 PH according to smoking status and SI. Spearman correlation coefficient was used to test the correlation between SI and the index of group 3 PH severity. The predictive value of SI was evaluated using a receiver operating characteristic (ROC) curve.Results: Correlation and logistic analyses showed that SI was associated with PH severity. Smoking status (P=0.009) and SI (P=0.039) were independent risk factors for non-mild group 3 PH, and ROC showed that the predictive value of SI (AUC:0.596) for non-mild PH was better than that of the recognized pro-brain natriuretic peptide (NT-proBNP) (AUC:0.586). SI can be used as a single predictive marker. SI and NT-proBNP can be formulated as prediction models for screening non-mild clinical cases (AUC:0.628).Conclusion: SI is a potentially ideal non-invasive predictive marker for group 3 PH. SI and NT-proBNP could be used to develop a prediction model for screening non-mild PH cases. This can greatly improve the predictive specificity of the established PH marker, NT-proBNP.Keywords: smoking index, NT-proBNP, pulmonary hypertension, chronic lung disease, predictive value

Abstract Aims As part of the Toon Health Study, which is an ongoing population‐based cohort study, we aimed to develop a prediction model for N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in a general Japanese population. We sought to explore the influence of various demographic and clinical factors on NT‐proBNP levels and assess the model's performance. In addition, our objectives included internal validation and investigation of the diagnostic potential of the observed‐to‐predicted NT‐proBNP ratio (OPR) at baseline for predicting the risk of heart failure with preserved ejection fraction (HFpEF). Methods and results In this prospective cohort study, participants were recruited from Toon City, Japan, as part of the larger Toon Health Study, focusing on cardiovascular risk factors. We measured the NT‐proBNP levels and used linear regression with penalization (ridge regression) to develop the model. The model incorporated 10 prespecified predictors (age, gender, body mass index, diastolic blood pressure, heart rate, haemoglobin, albumin, total cholesterol, haemoglobin A1c, and estimated glomerular filtration rate) and underwent assessment using R2 and root mean squared error (RMSE). Internal validation was conducted through bootstrapping. In a post hoc analysis, we explored the OPR's diagnostic potential using 5 year follow‐up data (n = 636) to predict the elevation of NT‐proBNP > 125 pg/mL at the 5 year follow‐up as the risk of HFpEF. A total of 2505 participants (age: 60.4 ± 12.9 years, men: 35%) were enrolled in this study. There was a linear relationship between the observed and predicted values of NT‐proBNP in which the logarithm of observed NT‐proBNP was 125 pg/mL at the 5 year follow‐up with an area under the curve of 0.793. Conclusions This study introduces the first prediction model for NT‐proBNP in a general Japanese population. Although the model has acceptable performance, ongoing refinement is essential. Our transparent approach to model development, alongside a web‐based interactive tool, lays the groundwork for further improvements and external validation. The OPR holds potential for predicting the future risk of HFpEF. This research contributes to understanding the nuanced influence of patient backgrounds on levels of NT‐proBNP in asymptomatic individuals within the context of a broader population‐based cohort study.

Aim. To evaluate the levels of soluble growth stimulator gene 2 (sST2) protein and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute coronary syndrome (ACS) depending on the presence of concomitant subclinical hypothyroidism (SH). Materials and methods. 125 patients with ACS aged 36 to 81 years (mean age – 60.98 ± 0.81 years) were included in the study. All the patients were divided into two groups according to the state of thyroid function. Group I consisted of 51 patients (40.8 %) with SH (thyroid-stimulating hormone (TSH) level >4 μIU/mL), mean age – 62.51 ± 1.18 years; Group II – 74 patients (59.2 %) with normal thyroid function (TSH level 0.4–4.0 μIU/mL), mean age – 59.93 ± 1.08 years. The state of SH was diagnosed at a TSH level of >4.0 μIU/mL and a serum free thyroxine (FT4) level within the normal range. Results. In the group of patients with ACS and SH (I), significantly higher mean levels of sST2 and NT-proBNP have been found compared to patients without thyroid dysfunction (II), 46.6 (27.9; 57.7) ng/ml (I) vs. 29.9 (22.0; 38.5) ng/ml (II), p = 0.001 and 173.0 (103.4; 1005.1) ng/l (I) vs. 95.9 (71.8; 178.6) ng/l (II), p = 0.0001, respectively. Among patients with ACS and SH (I), the sST2 level of 35–70 ng/ml was 1.94 times more often, and sST2 >70 ng/ml was 2.28 times more often as compared to those in patients with ACS without thyroid dysfunction (II), 22.74 % (47.06 ± 6.99 % (I) vs. 24.32 ± 4.99 % (II), p = 0.008) and 15.81 % (21.57 ± 5.76 % (I) vs. 9.46 ± 3.40 % (II), p < 0.05), respectively. The study on NT-proBNP levels in ACS patients with SH (I) has revealed a 75.67 % significantly higher proportion of individuals with NT-proBNP levels > 600 ng/L (33.33 ± 6.60 % (I)) as compared to ACS patients with normal thyroid function (II) (8.11 ± 3.17 % (II), p = 0.001). The level of NT-proBNP 600 ng/L have been detected compared to the group of ACS patients with normal thyroid function. These results may indicate a higher risk of development, progression and complications of heart failure due to a higher probability of myocardial fibrosis and subsequent left ventricular remodeling in ACS patients with SH. The significant strong positive correlation has been found between the mean levels of sST2 and NT-proBNP in the group of ACS patients with SH (I) (r = 0.775, p < 0.001). In the group of ACS patients with normal thyroid function (II), the correlation between the mean levels of sST2 and NT-proBNP was less pronounced (r = 0.678, p < 0.001). Combined assessment of these biomarkers may be more informative for the diagnosis and prognosis of heart failure in ACS patients with concomitant thyroid dysfunction than measurements of individual biomarkers. In particular, the simultaneous increase in sST2 and NT-proBNP above reference values allows to identify a very high-risk group for heart failure occurrence and progression in ACS patients.

Background. Heart failure (HF) is the final stage of the cardiovascular diseases and one of the main causes of mortality due to them. The prevalence of HF has been steadily increasing in recent years and is ≈ 2 % of the adult population. Diabetes mellitus (DM) is among factors that worsen the prognosis of HF. Type 2 DM is an independent risk factor for the occurrence of HF, and the level of fasting plasma glucose, as well as an increased content of HbA1c are significantly associated with an elevated risk of developing HF. The purpose of the study was to investigate the features of the course of HF, which occurred against the background of postinfarction cardiosclerosis, in patients with concomitant atrial fibrillation (AF) and DM. Materials and methods. Three hundred and ninety-eight patients with HF on the background of postinfarction cardiosclerosis aged 45–65 (54.3 ± 7.2) years were examined, 198 (49.7 %) women and 200 (50.3 %) men. Two hundred and twenty-six (56.8 %) patients had permanent AF, 102 (25.6 %) had concomitant type 2 DM. Diagnoses of AF and HF were carried out in accordance with the clinical protocol for providing medical care to patients with atrial fibrillation and heart failure approved by the Order of the Ministry of Health of Ukraine dated July 3, 2006 No. 436 and in accordance with the 2021 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure. In addition to general clinical and biochemical blood tests, enzyme immunoassays were performed to determine brain natriuretic peptide, NT-proBNP, galectin-3 and ST-2. A standardized echocardiographic examination was conducted with calculations of the left ventricular ejection fraction (LVEF) and heart dimensions during hospitalization. Results. Patients with HF and concomitant DM, compared to participants without impaired carbohydrate metabolism, have a higher frequency of the disease phenotype with preserved LVEF (48.0 %), higher New York Heart Association functional classes (FC III — 70.0 %) and the risk of re-hospitalization (hazard ratio (HR) = 3.14 (2.05–5.68)). For patients with HF and a permanent AF, but without existing DM, a more pronounced dilatation of the heart cavities, a lower LVEF (by 15 %) and a high risk of re-hospitalization during the first year (HR = 1.235 (1.024–1.489)) are typical. Patients with HF and a concomitant combination of AF and DM have the most unfavorable course of heart pathology: the increased size of the left ventricle is more often registered, and its systolic function is worse (by 19.3 %), with high frequency of the phenotype with reduced LVEF (51.9 %), FC IV (46.2 %), the highest risk of re-hospitalization (HR = 11.30 (4.73–27.04)) and one-year death (HR = 2.95 (2.00–4.36)). Conclusions. Given the risk of re-hospitalization and one-year mortality, the most unfavo­rable combination of concomitant pathology in patients with heart failure of ischemic origin is atrial fibrillation and diabetes mellitus.

Abstract Background It is essential to find reliable biomarkers for early diagnosis and prognosis of acute heart failure (AHF) for its mitigation. Currently, increasing attention is paid to the role of microRNAs (miRNAs/miRs) as diagnostic or prognostic markers for cardiovascular diseases. Since plasma miR-106a-5p has been observed to be downregulated in AHF, its value in the diagnosis and prognostic assessment of AHF deserves further exploration. Accordingly, this study analyzed the diagnostic and prognostic value of plasma miR-106a-5p in AHF patients. Methods Prospectively, this study included 127 AHF patients who met the 2021 European Society of Cardiology Guidelines and 127 control individuals. Plasma miR-106a-5p levels were determined with RT-qPCR. Spearman correlation analysis was performed to evaluate the correlation of plasma miR-106a-5p levels with NT-proBNP and hs-CRP levels in AHF patients. All AHF patients were followed up for 1 year and allocated into poor and good prognosis groups, and plasma miR-106a-5p levels were compared. The diagnostic and prognostic value of plasma miR-106a-5p for AHF was assessed with a receiver-operating characteristic curve. Results Plasma miR-106a-5p was lowly expressed in AHF patients versus controls (0.53 ± 0.26 vs. 1.09 ± 0.46) and showed significant negative correlations with NT-proBNP and hs-CRP levels. Plasma miR-106a-5p level

Abstract Aim Diagnosing and classifying heart failure (HF) in the oldest-old patients has technical and interpretation issues, especially in the acute setting. We assessed the usefulness of both N-terminal pro-brain natriuretic peptide (NT-proBNP) and lung ultrasound (LUS) for confirming HF diagnosis and predicting, among hospitalized HF patients, those with reduced ejection fraction (HFrEF). Methods We performed a cross-sectional study on 148 consecutive patients aged ≥ 80 years admitted to our Internal Medicine and Geriatrics ward with at least one symptom/sign compatible with HF and NT-proBNP ≥ 125 pg/mL. We measured serum NT-proBNP levels and performed LUS and transthoracic echocardiography (TTE) on admission before diuretic therapy. We divided our cohort into three subgroups according to the left ventricular ejection fraction (LVEF): reduced (LVEF ≤ 40%), mildly-reduced (LVEF = 41-49%) and preserved (LVEF ≥ 50%). Results The mean age was 88±5 years. Male prevalence was 42%. Patients with HFrEF were 19%. Clinical features and laboratory parameters did not differ between the three subgroups, except for higher NT-proBNP in HFrEF patients, which also had a higher number of total B-lines and intercostal spaces of pleural effusion at LUS. Overall, NT-proBNP showed an inverse correlation with LVEF (r = -0.22, p = 0.007) and a direct correlation with age, total pulmonary B-lines, and intercostal spaces of pleural effusion. According to the ROCs, NT-proBNP levels, pulmonary B-lines and pleural effusion extension were poorly predictive for HFrEF. The best-performing cut-offs were 9531 pg/mL for NT-proBNP (SP 0.70, SE 0.50), 13 for total B-lines (SP 0.69, SE 0.85) and one intercostal space for pleural effusion (SP 0.55, SE 0.89). Patients with admission NT-proBNP ≥ 9531 pg/mL had a 2-fold higher risk for HFrEF (OR 2.5, 95% CI 1.3-4.9), while we did not find any association for total B-lines ≥ 13 or pleural effusion ≥ 1 intercostal space with HFrEF. A significant association with HFrEF emerged for the combination of NT-proBNP ≥ 9531 pg/mL, total B-lines ≥ 13 and intercostal spaces of pleural effusion ≥ 1 (adjusted OR 4.3, 95% CI 1.5-12.9). Conclusions Although NT-proBNP and LUS help diagnose HF, their accuracy in discriminating HFrEF from non-HFrEF was poor in our real-life clinical study on oldest-old hospitalized patients, making the use of TTE still necessary to distinguish HF phenotypes in this peculiar setting. These data require confirmation in more extensive and longer prospective studies.

Abstract Objectives To investigate the association between radiotherapy (RT) and cardiac biomarkers in women with left-sided breast cancer. Methods This prospective observational study recruited patients with stage I-III left-sided breast cancer without coronary heart disease who required adjuvant RT. High-sensitivity troponin I(hsTnI), N-terminal pro-brain natriuretic peptide(NT-proBNP), and high-sensitivity C-reactive protein(hsCRP) levels were measured pre-RT, immediately after RT, and 3 months post-RT. Cardiac-sparing RT techniques were utilized (Field-in-Field IMRT/VMAT ± voluntary deep inspiration breath-hold). Statistical analyses were performed using non-parametric tests and multivariable quantile regression (QR). Results One hundred five patients completed the study, with 63 evaluable at three months post-RT. Pre- and post-RT biomarkers showed no significant differences. Median pre-RT and post-RT values were: hsTnI (0.012ng/mL; 0.012ng/mL), hsCRP (3.1 mg/L; 2.8 mg/L), and NT-proBNP (59pg/mL; 45pg/mL). Three months post-RT, hsTnI, hsCRP and NT-proBNP levels also showed no significant differences. Multivariable QR revealed no association between heart Dmean [median(IQR): 2.87 Gy (2.05–3.94)] and post-RT biomarkers. Age and BMI were associated with hsCRP and NT-proBNP, respectively. Conclusions hsTnI, NT-proBNP, and hsCRP are not correlated with contemporary low cardiac exposure in left-sided breast cancer patients treated with contemporary RT techniques.

Abstract Aims In patients with heart failure (HF), we aimed to assess (i) the time trends in N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) testing; (ii) patient characteristics associated with NT‐proBNP testing; (iii) distribution of NT‐proBNP levels, focusing on the subgroups with (WHFE) vs. without (NWHFE) a worsening HF event, defined as an HF hospitalization; and (iv) changes of NT‐proBNP levels over time. Methods and results NT‐proBNP testing and levels were investigated in HF patients enrolled in the Swedish Heart Failure Registry (SwedeHF) linked with the Stockholm CREAtinine Measurements project from January 2011 to December 2018. Index date was the first registration in SwedeHF. Patterns of change in NT‐proBNP levels before (in the previous 6 ± 3 months) and after (in the following 6 ± 3 months) the index date were categorized as follows: (i)

Background: The sulfide–hydrogen sulfide brine balneotherapy (HSBB), including a combination of dissolved hydrogen sulfide (H2S) gas, inorganic sulfur ions (S2−), and hydrosulfide ions (HS−), is one of the most important and most effective forms of spa treatment in patients with osteoarticular disorders (OADs). Some cardiovascular diseases (CVDs) are often considered to be contraindications to HSBB since the presence of thiol groups may lead to an increased quantity of reactive oxygen species (ROS), which damage the vascular endothelium, and endothelial dysfunction is considered to be the main cause of atherosclerosis. However, there are a number of literature reports suggesting this theory to be false. H2S is a member of the endogenous gaseous transmitter family and, since it is a relatively recent addition, it has the least well-known biological properties. H2S–NO interactions play an important role in oxidative stress in CVDs. The general objective of this study was to assess the cardiovascular safety of HSBB and analyze the effect of HSBB on selected cardiovascular risk markers. Methods: A total of 100 patients at the age of 76.3 (±7.5) years from the Włókniarz Sanatorium in Busko-Zdrój were initially included in the study. The following parameters were assessed: age, sex, height, body weight, body surface area (BSA), body mass index (BMI), systolic (SBP) and diastolic blood pressure (DBP), heart rate, the diagnosis of OAD that was the indication for balneotherapy, creatinine (CREAT), glomerular filtration rate (GFR), lipid panel, C-reactive protein (CRP), uric acid (UA), and fibrinogen (FIBR) and cardiovascular markers: (cardiac troponin T (cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP). Results: A significant decrease in DBP and a trend towards SBP reduction were observed over the course of the study. A significant decrease was observed in CRP levels decreasing from 2.7 (±3.6) mg/L to 2.06 (±1.91) mg/L, whereas FIBR rose significantly from 2.95 (±0.59) g/L to 3.23 (±1.23) g/L. LDL-C levels decreased slightly, statistically significant, from 129.36 (±40.67) mg/dL to 123.74 (±36.14) mg/dL. HSBB did not affect the levels of evaluated cardiovascular biomarkers, namely NT-proBNP (137.41 (±176.52) pg/mL vs. 142.89 (±182.82) pg/mL; p = 0.477) and cTnT (9.64 (±4.13) vs. 9.65 (±3.91) ng/L; p = 0.948). A multiple regression analysis of pre-balneotherapy and post-balneotherapy values showed cTnT levels to be independently correlated only with CREAT levels and GFR values. None of the assessed parameters independently correlated with the NT-proBNP level. Conclusions: HSBB resulted in a statistically significant improvement in a subclinical pro-inflammatory state. HSBB has a beneficial effect in modifying key cardiovascular risk factors by reducing LDL-C levels and DBP values. HSBB has a neutral effect on cardiovascular ischemia/injury. Despite slightly elevated baseline levels of the biochemical marker of HF (NT-proBNP), HSBB causes no further increase in this marker. The use of HSBB in patients with OAD has either a neutral effect or a potentially beneficial effect on the cardiovascular system, which may constitute grounds for further studies to verify the current cardiovascular contraindications for this form of therapy. [ABSTRACT FROM AUTHOR]

Background N-terminal pro–brain natriuretic peptide (NT-proBNP) is a cardiac biomarker associated with the risk of heart failure and death in the general population, but it has not been explored in cancer survivors. Methods Using a US nationally representative sample of adults 20 years of age and older from the National Health and Nutrition Examination Survey from 1999 to 2004, this study compared NT-proBNP levels between adults without cancer (n = 12 574) and adult cancer survivors (n = 787). It examined the association of NT-proBNP with all-cause and cause-specific mortality among cancer survivors. Results Cancer survivors had higher NT-proBNP levels than adults without cancer (median [interquartile range] = 125.4 pg/mL [52.4-286.0] vs 43.2 pg/mL [20.3-95.0]). In particular, survivors of breast, prostate, and colorectal cancers had higher NT-proBNP levels than adults without cancer (multivariable-adjusted P  < .05). In total, 471 survivors died (141 from cancer; 95 from cardiac disease) during a median follow-up period of 13.4 years (9393 person-years). Among cancer survivors, higher NT-proBNP levels were statistically associated with increased risks of all-cause death (hazard ratio [HR] = 1.31, 95% confidence interval [CI] = 1.18 to 1.46) and cardiac death (HR = 1.55, 95% CI = 1.21 to 2.00) but not with death from cancer (HR = 1.10, 95% CI = 0.92 to 1.32]). Higher NT-proBNP levels were associated with elevated overall mortality in survivors of prostate cancer (HR = 1.49, 95% CI = 1.22 to 1.81) and colorectal cancer (HR = 1.78, 95% CI = 1.00 to 3.16) (P  = .169 for interaction). Nonlinear dose-response relationships were observed between NT-proBNP and mortality, with statistically significant relationships emerging above 125 pg/mL. Conclusions Cancer survivors had higher NT-proBNP levels than adults without cancer, and elevated NT-proBNP levels were associated with higher risks of all-cause and cardiac mortality in cancer survivors. [ABSTRACT FROM AUTHOR]

Background: Patients with juvenile idiopathic arthritis (JIA) have a higher risk of cardiac problems, such as left heart failure. Clinical prognostic significance can be found in the examination of the left ventricle utilising conventional two-dimensional echocardiography, tissue doppler and two-dimensional speckle-tracking echocardiography along with monitoring NT-proBNP level. Objectives: This study aimed to accurately evaluate of cardiac functions in children with JIA compared to matched healthy controls. Subjects and methods: This case control study was conducted at Department of Pediatrics, Cardiology Unit, Rheumatology clinic and Clinical Pathology Department at Zagazig University Hospital on forty children who were allocated into two groups: control group: Twenty apparently normal, healthy children matched to case regarding to age and sex and case group: Twenty children with Juvenile rheumatoid arthritis and on regular follow-up once/month. NT-proBNP and echocardiography were assessed for all children. Results: There was significant variations were detected between case and control groups for TAPSE and TAPSE/RVSP ratio, which were lower in the case group, and RVSV, LVEDD, LVESD, LVEDV, and LVESV, which was higher in the case group. No remarkable variations were observed for TR. There was no marked variations between both groups concerning LV longitudinal strain, LV size, right and left ventricle free wall longitudinal axes strain velocities using 2D speckle tracking except Rv4csl that was significant higher in cases than control (p<0.0001). Conclusion: Regular cardiac monitoring is crucial in the early detection and management of heart disease in JIA cases, findings from an echocardiogram can help justify aggressive treatment for young cases diagnosed with juvenile rheumatoid arthritis and assess the progression of the disease in these patients. [ABSTRACT FROM AUTHOR]

• NT-proBNP concentrations are higher in pregnancy than in nonpregnancy. • Increased NT-proBNP levels may predict adverse outcomes in preeclamptic women. • Some studies found that the more severe preeclampsia was, the higher NT-proBNP was. • Early-onset preeclamptic women have higher NT-proBNP than those with late-onset. N-terminal prohormone of brain natriuretic peptide (NT-proBNP) is a non-active prohormone secreted by ventricular cardiomyocytes into the circulation in response to ventricle overload, mainly due to increased blood volume. The changes in NT-proBNP levels during pregnancy have been investigated in multiple studies. In the case of hypertensive disorders of pregnancy, increased vasoconstriction leads to increased blood pressure and afterload. Together with the volume overload of pregnancy, it leads to higher NT-proBNP secretion. As hypertensive disorders of pregnancy are among the leading causes of prematurity and perinatal mortality, early prediction and diagnosis of gestational hypertension, and preeclampsia are essential for improving maternal and infant prognosis. NT-proBNP has been regarded as a potential biomarker of hypertensive disorders of pregnancy. In this review, we have thoroughly summarized the current data on the prognostic and diagnostic utility of NT-proBNP in patients with gestational hypertension and preeclampsia. NT-proBNP values may help distinguish between non-preeclamptic and preeclamptic patients, even if there are no significant differences in blood pressure. Moreover, in pregnancies complicated by preeclampsia, the value of increased NT-proBNP level is related to the stage and the severity of the disease. Further improvement of our knowledge about NT-proBNP as a diagnostic biomarker and a putative predictor of adverse cardiac events in women with hypertensive disorders of pregnancy should lead to better management of these patients. [ABSTRACT FROM AUTHOR]

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Aims: As part of the Toon Health Study, which is an ongoing population‐based cohort study, we aimed to develop a prediction model for N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in a general Japanese population. We sought to explore the influence of various demographic and clinical factors on NT‐proBNP levels and assess the model's performance. In addition, our objectives included internal validation and investigation of the diagnostic potential of the observed‐to‐predicted NT‐proBNP ratio (OPR) at baseline for predicting the risk of heart failure with preserved ejection fraction (HFpEF). Methods and results: In this prospective cohort study, participants were recruited from Toon City, Japan, as part of the larger Toon Health Study, focusing on cardiovascular risk factors. We measured the NT‐proBNP levels and used linear regression with penalization (ridge regression) to develop the model. The model incorporated 10 prespecified predictors (age, gender, body mass index, diastolic blood pressure, heart rate, haemoglobin, albumin, total cholesterol, haemoglobin A1c, and estimated glomerular filtration rate) and underwent assessment using R2 and root mean squared error (RMSE). Internal validation was conducted through bootstrapping. In a post hoc analysis, we explored the OPR's diagnostic potential using 5 year follow‐up data (n = 636) to predict the elevation of NT‐proBNP > 125 pg/mL at the 5 year follow‐up as the risk of HFpEF. A total of 2505 participants (age: 60.4 ± 12.9 years, men: 35%) were enrolled in this study. There was a linear relationship between the observed and predicted values of NT‐proBNP in which the logarithm of observed NT‐proBNP was <6, which corresponds to 403 pg/mL in NT‐proBNP. The prediction model demonstrated satisfactory performance (R2: 0.291, RMSE: 0.688), with age identified as a dominant predictor. The stability of the model was underscored by the internal validation. The OPR at baseline predicted NT‐proBNP > 125 pg/mL at the 5 year follow‐up with an area under the curve of 0.793. Conclusions: This study introduces the first prediction model for NT‐proBNP in a general Japanese population. Although the model has acceptable performance, ongoing refinement is essential. Our transparent approach to model development, alongside a web‐based interactive tool, lays the groundwork for further improvements and external validation. The OPR holds potential for predicting the future risk of HFpEF. This research contributes to understanding the nuanced influence of patient backgrounds on levels of NT‐proBNP in asymptomatic individuals within the context of a broader population‐based cohort study. [ABSTRACT FROM AUTHOR]

Aims: Heart failure (HF) with preserved ejection fraction (HFpEF) is a disease associated with high morbidity and mortality, for which it is difficult to identify patients with the poorest prognosis in routine clinical practice. Carbohydrate antigen 125 (CA 125) has been shown to be a potential marker of congestion and prognosis in HF. We sought to better characterize HFpEF patients with high CA 125 levels by using a multimodal approach. Methods and results: We prospectively enrolled 139 HFpEF patients (78 ± 8 years; 60% females) and 25 controls matched for age and sex (77 ± 5 years; 60% females). They underwent two‐dimensional echocardiography, cardiac magnetic resonance with late gadolinium enhancement [including extracellular volume (ECV) measurement], and serum measurements of CA 125 level. The primary endpoint of the study was a composite of all‐cause mortality or first HF hospitalization. The prognostic impact of CA 125 was determined using Cox proportional hazard models. Median CA 125 levels were significantly higher in HFpEF patients compared with controls [CA 125: 23.5 (14.5–44.7) vs. 14.6 (10.3–21.0) U/mL, P = 0.004]. CA 125 levels were positively correlated with a congestion marker [N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) levels, Pearson's r = 0.37, P < 0.001] and markers of cardiac fibrosis estimated by both ECV (Pearson's r = 0.26, P = 0.003) and fibroblast growth factor 23 levels (Pearson's r = 0.50, P < 0.001). Over a median follow‐up of 49 (22–64) months, 97 HFpEF patients reached the composite endpoint. Even after adjustment for the Meta‐Analysis Global Group in Chronic risk score, a CA 125 level ≥35 U/mL was still a significant predictor of the composite endpoint [hazard ratio (HR): 1.58 (1.04–2.41), P = 0.032] and more particularly of HF hospitalization [HR: 1.81 (1.13–2.92), P = 0.014]. In contrast, NT‐proBNP levels were not an independent predictor. Conclusions: CA 125 levels were significantly higher in HFpEF patients compared with controls matched for age and sex and were associated with markers of congestion and cardiac fibrosis. CA 125 levels were a strong and independent predictor of HF hospitalization in HFpEF patients. These data suggest a potential value of CA 125 as a biomarker for staging and risk prediction in HFpEF. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical value of echocardiography combined with N-terminal pro-brain natriuretic peptide (NT-proBNP) and long non-coding RNA (1ncRNA) taurine-upregulated gene 1 (TUG1) in elderly patients with hypertension and heart failure with preserved ejection fraction (HFPEF) . Methods: 82 elderly patients with hypertension and HFPEF who were diagnosed and treated in Handan First Hospital from March 2021 to March 2022 were selected as the study group. According to new York Heart Association (NYHA) cardiac function classification, the patients were divided into subgroup A (Ⅰ～Ⅱ) 48 cases and subgroup B (Ⅲ～Ⅳ) 34 cases. In addition, 74 elderly patients with hypertension without HFPEF who were examined during the same period were selected as the control group. The cardiac ultrasound parameters of all subjects were recorded, and their serum NT-proBNP and TUG1 levels were detected. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of ultrasound parameters combined with NT-pro BNP and TUG1 in elderly patients with hypertension and HFPEF, and to evaluate the value of ultrasound parameters in evaluating the severity of elderly patients with hypertension and HFPEF. Results: The left atrial diameter (LAD), serum NT-proBNP and TUG-1 levels in study group were higher than those in control group, and the ratio of early diastolic mitral flow velocity to late diastolic mitral flow velocity (E/A) was lower than that in control group (P＜0.05) . The LAD, NT-proBNP and TUG1 levels in subgroup B were higher than those in subgroup A, and E/A was lower than that in subgroup A (P＜0.05) . The results of ROC curve analysis showed that the area under the curve (AUC), sensitivity and specificity of LAD, E/A combined with serum NT-proBNP and TUG1 in the evaluation of elderly hypertension with HFPEF were 0.876, 0.854 and 0.838, respectively. At the same time, the AUC, sensitivity and specificity of LAD, E/A combined with serum NT-proBNP and TUG1 in evaluating the severity of elderly hypertension with HFPEF were 0.851, 0.853and 0.833, respectively, the combined evaluation efficiency was better than that of each index alone. Conclusion: Cardiac ultrasound parameters, NT-proBNP and TUG-1 have certain clinical value in the diagnosis and evaluation of elderly hypertensive patients with HFPEF, and LAD, E/A parameters combined with serum NT-proBNP and TUG-1 have higher value. [ABSTRACT FROM AUTHOR]

Background: Ftost-operative atrial fibrillation (POAF) is a frequent complication after cardiac surgery. It is associated with prolonged hospital stay, increased morbidity, mortality rate and economic costs. The aim of the study was to determine the association between the values of Galectin-3 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) with POAF after cardiac surgery. Methods: A prospective study enrolled patients aged 18-85 years old admitted due to elective coronary artery bypass graft surgery (CABG) or CABG + aortic valve replacement. The plasma Galectin-3 and NT-proBNP levels were measured one day before surgery postoperative days 1 and 7. Results: The study included a total of 103 patients. POAF was registered in 45 patients. The mean age of patients in whom POAF occurred was 68.8 years, while other patients' mean age was 65.5 years (p= 0.028). Patients with POAF did not differ from the group without POAF in the values of Galectin-3 and NT-proBNP preoperatively as well as on the first and seventh postoperative days. Changes in Galectin-3 levels on the first postoperative day had statistically significant value for predicting POAF (AUC=0.627 [0.509-0.745], p<0.05). Decrease in Galectin-3 level concentration on the first postoperative day over 17% increases the risk of developing AF. Conclusions: Preoperative values of Galectin-3 and NT- proBNP are not associated with POAF development after cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Patients with end-stage kidney disease (ESKD) are at high risk of cardiovascular disease including stroke, heart failure, and ischemic heart disease (IHD). To prevent the occurrence and progression of CVD, a reliable prognostic cardiac biomarker is essential. We investigated the prognostic value of NT-proBNP for each incident type of CVD. Methods: Male patients from the Ibaraki Dialysis Initiation Cohort (iDIC) study with preserved serum samples from dialysis initiation day (n = 212) were analyzed. Patients were classified into four groups according to quartiles of baseline NT-pro BNP levels. The relationship between NT-proBNP levels at the initiation of dialysis and the subsequent incidence of hospitalization events due to IHD, heart failure, and stroke was analyzed. Results: The incidence rate for hospitalization due to IHD was significantly higher in the highest NT-proBNP category (Log rank p = 0.008); those of stroke and heart failure showed no significant differences among quartiles. Cox proportional hazards regression analysis revealed that serum NT-proBNT was the only prognostic factor for hospitalization for IHD after adjustment by major known IHD risk factors. (HR, 1.008; 95% confidence interval, 1.002–1.014; p = 0.01) The ROC curve analysis for the incidence of hospitalization due to IHD showed that NT-proBNP had an area under the curve (AUC) of 0.759 (95% CI 0.622–0.897; p = 0.004) at a cut-off value of 956.6 pg/mL. Conclusion: NT-proBNP measurement at the initiation of dialysis therapy is useful to predict later hospitalization for IHD. Trial registration: UMIN000010806. [ABSTRACT FROM AUTHOR]

More than 26 million people in the world suffer from heart failure and heart dysfunction. Examination of patients with both diseases, especially in the deceased, is very difficult due to lack of medical records, limitations of clinical examination and morphological changes that are not visible to the naked eye. Today, BNP and NT-proBNP have been widely used as significant indicators for the diagnosis of heart failure and cardiac dysfunction, both in clinical and forensic fields, and numerous studies have examined the usefulness of BNP and NT-proBNP from all sides in clinical and forensic fields. The purpose of this article is to discuss biological features, current research related to their applications and future research prospects of BNP and NT-proBNP in clinical and forensic fields. The method used in this study is a literature study, by collecting and analyzing relevant literature related to the role of BNP and NT-proBNP in the diagnosis, therapy, and prognosis of heart disease. BNP and NT-proBNP are important biomarkers in clinical and forensic fields for heart disease assessment. With technological developments in the field of molecular biology, it is expected that the use of BNP and NT-proBNP can become more precise and accurate in the future, improving diagnosis, treatment, and understanding of heart disease in both living and post-mortem patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the value of real-time three-dimensional echocardiography (RT-3DE) combined with serum N-terminal pro-brain natriuretic peptide(NT-proBNP), mid-regional pro-adrenomedullin(MR-proADM) and soluble suppression of tumorigenicity 2 (sST2) in the diagnosis and prognosis of patients with heart failure (HF). Methods: 112 HF patients (HF group) admitted to Sunshine Union Hospital from March 2020 to October 2022 were selected, and another 50 volunteers (control group) who underwent physical examination during the same period were selected. All subjects underwent RT-3DE examination, and serum NT-proBNP, MR-proADM and sST2 levels were detected. RT-3DE parameters and serum NT-proBNP, MR-proADM, sST2 levels were compared between two groups. HF patients were followed up for 6 months after discharge, and the prognosis situation of patients were counted; patients were divided into poor prognosis group (37 cases) and good prognosis group (75 cases) according to the prognosis. The clinical value of RT-3DE parameters combined with serum NT-proBNP, MR-proADM and sST2 in the diagnosis of HF and the predictive value for poor prognosis were analyzed by receiver operating characteristic (ROC) curve. Results: The levels of left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic volume index (LVEDVI), end-systolic volume index (LVESVI), serum NT-proBNP, MR-proADM and sST2 in HF group were higher than those in control group (P<0.05), and left ventricular ejection fraction (LVEF) was lower than that in control group (P<0.05). The area under the curve (AUC) of RT-3DE parameters combined with serum NT-proBNP, MR-proADM and sST2 in the diagnosis of HF was 0.902, which was higher than that of each index alone. LVESV, LVEDV, LVEDVI, LVESVI, serum NT-proBNP, MR-proADM and sST2 levels in poor prognosis group were higher than those in good prognosis group (P<0.05), and LVEF was lower than that in good prognosis group (P<0.05). The AUC of RT-3DE parameters combined with NT-proBNP, MR-proADM and sST2 in predicting the poor prognosis of HF was 0.937, which was higher than that of each index alone. Conclusion: The levels of LVESV, LVEDV, LVEDVI, LVESVI, serum NT-proBNP, MR-proADM and sST2 increased and LVEF decreased in HF patients, RT-3DE parameters combined with serum NT-proBNP, MR-proADM and sST2 could improve the efficacy of HF diagnosis and prognosis prediction. [ABSTRACT FROM AUTHOR]

This study investigates the association between maximal functional capacity (peakVO 2) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in 133 ambulatory patients with heart failure with preserved ejection fraction (HFpEF), focusing on patients with obesity. Across all participants, NT-proBNP inversely correlated with peakVO 2. However, this association varied based on obesity status. In patients without obesity, there was an inverse relationship between NT-proBNP and peakVO 2 , while no significant correlation was observed in patients with obesity. These findings suggest that in stable ambulatory HFpEF, NT-proBNP did not predict peakVO 2 in patients with obesity. • Higher NT-proBNP levels were significantly but marginally associated with lower peakVO 2 in symptomatic patients with HFpEF. • The association between NT-proBNP and peakVO 2 largely differed across obesity, being non-significant in patients with obesity. • These findings endorse the limitations of natriuretic peptides in assessing patients with HFpEF and obesity. [ABSTRACT FROM AUTHOR]

Aim. To evaluate the levels of soluble growth stimulator gene 2 (sST2) protein and N-terminal pro-brain natriuretic peptide (NTproBNP) in patients with acute coronary syndrome (ACS) depending on the presence of concomitant subclinical hypothyroidism (SH). Materials and methods. 125 patients with ACS aged 36 to 81 years (mean age - 60.98 ± 0.81 years) were included in the study. All the patients were divided into two groups according to the state of thyroid function. Group I consisted of 51 patients (40.8 %) with SH (thyroid-stimulating hormone (TSH) level >4 μIU/mL), mean age - 62.51 ± 1.18 years; Group II - 74 patients (59.2 %) with normal thyroid function (TSH level 0.4-4.0 μIU/mL), mean age - 59.93 ± 1.08 years. The state of SH was diagnosed at a TSH level of >4.0 μIU/mL and a serum free thyroxine (FT4) level within the normal range. Results. In the group of patients with ACS and SH (I), significantly higher mean levels of sST2 and NT-proBNP have been found compared to patients without thyroid dysfunction (II), 46.6 (27.9; 57.7) ng/ml (I) vs. 29.9 (22.0; 38.5) ng/ml (II), p = 0.001 and 173.0 (103.4; 1005.1) ng/l (I) vs. 95.9 (71.8; 178.6) ng/l (II), p = 0.0001, respectively. Among patients with ACS and SH (I), the sST2 level of 35-70 ng/ml was 1.94 times more often, and sST2 >70 ng/ml was 2.28 times more often as compared to those in patients with ACS without thyroid dysfunction (II), 22.74 % (47.06 ± 6.99 % (I) vs. 24.32 ± 4.99 % (II), p = 0.008) and 15.81 % (21.57 ± 5.76 % (I) vs. 9.46 ± 3.40 % (II), p < 0.05), respectively. The study on NT-proBNP levels in ACS patients with SH (I) has revealed a 75.67 % significantly higher proportion of individuals with NT-proBNP levels > 600 ng/L (33.33 ± 6.60 % (I)) as compared to ACS patients with normal thyroid function (II) (8.11 ± 3.17 % (II), p = 0.001). The level of NT-proBNP <125 ng/l has been detected 2.31 times more often in the group of ACS patients with normal thyroid function (II) compared to that in ACS patients with SH (I), by 36.06 % (63.51 ± 5.60 % (II) vs. 27.45 ± 6.25 % (I), p = 0.00002). A significant strong positive correlation has been found in the group of ACS patients with SH (I) (correlation coefficient (r) = 0.775, p < 0.001) in assessing the relationship between the mean levels of sST2 and NT-proBNP. In the group of ACS patients with normal thyroid function (II), a moderate correlation has been found between the mean levels of sST2 and NT-proBNP (r = 0.678, p < 0.001). Conclusions. In the group of ACS patients with moderately reduced thyroid function (SH), significantly higher mean levels of sST2 and NT-proBNP and significantly higher percentage of individuals with sST2 levels ≥ 35 ng/mL, NT-proBNP >600 ng/L have been detected compared to the group of ACS patients with normal thyroid function. These results may indicate a higher risk of development, progression and complications of heart failure due to a higher probability of myocardial fibrosis and subsequent left ventricular remodeling in ACS patients with SH. The significant strong positive correlation has been found between the mean levels of sST2 and NT-proBNP in the group of ACS patients with SH (I) (r = 0.775, p < 0.001). In the group of ACS patients with normal thyroid function (II), the correlation between the mean levels of sST2 and NT-proBNP was less pronounced (r = 0.678, p < 0.001). Combined assessment of these biomarkers may be more informative for the diagnosis and prognosis of heart failure in ACS patients with concomitant thyroid dysfunction than measurements of individual biomarkers. In particular, the simultaneous increase in sST2 and NT-proBNP above reference values allows to identify a very high-risk group for heart failure occurrence and progression in ACS patients. [ABSTRACT FROM AUTHOR]

Background: The present study investigated the predictors of adverse outcomes in young adult patients with dilated cardiomyopathy (DCM) who underwent heart transplantation (HTx). Methods: Twenty-four young adult patients (aged 18-45 years) with DCM who underwent HTx in our hospital from January 2012 to December 2022 were included in this retrospective analysis. Pre- and post-HTx data were collected for echocardiography, N-terminal pro-brain natriuretic peptide (NT-proBNP), and uric acid (UA). Data collected at the time of DCM diagnosis were designated as baseline data. Post-HTx assessments were conducted at 1 week and 3, 6, 12, and 36 months post-HTx. The primary endpoint was defined as any adverse event, including left ventricular ejection fraction (LVEF) <50% (n = 3), 50% increase in right or left ventricular diameter (n = 12), or death (n = 2). Patients were categorized into a non-adverse-event group (n = 12) or an adverse-event group (n = 12). Results: Baseline NT-proBNP (p = 0.014) and UA (p = 0.012) were significantly higher in the adverse-event group than in the non-adverse-event group. Baseline NT-proBNP >7390 pg/mL (relative risk (RR) = 7.412, p = 0.046), UA >542 µmol/L (RR = 8.838, 95% confidence interval (95% CI) = 1.541-50.694, p = 0.014), and sustained reduction in LVEF (=3%) over a 2-year pharmacological treatment prior to HTx (RR = 3.252, p = 0.046) were significantly associated with an increased risk of adverse events post-HTx. Conclusions: In young adult DCM patients post-HTx, heightened baseline levels of NT-proBNP and UA levels and a sustained reduction in LVEF over time prior to undergoing an HTx are significantly associated with an increased risk of adverse events post-HTx. Future studies are needed to observe whether individualized monitoring strategies could reduce the incidence of adverse events following HTx in these patients. [ABSTRACT FROM AUTHOR]

Background: It is essential to find reliable biomarkers for early diagnosis and prognosis of acute heart failure (AHF) for its mitigation. Currently, increasing attention is paid to the role of microRNAs (miRNAs/miRs) as diagnostic or prognostic markers for cardiovascular diseases. Since plasma miR-106a-5p has been observed to be downregulated in AHF, its value in the diagnosis and prognostic assessment of AHF deserves further exploration. Accordingly, this study analyzed the diagnostic and prognostic value of plasma miR-106a-5p in AHF patients. Methods: Prospectively, this study included 127 AHF patients who met the 2021 European Society of Cardiology Guidelines and 127 control individuals. Plasma miR-106a-5p levels were determined with RT-qPCR. Spearman correlation analysis was performed to evaluate the correlation of plasma miR-106a-5p levels with NT-proBNP and hs-CRP levels in AHF patients. All AHF patients were followed up for 1 year and allocated into poor and good prognosis groups, and plasma miR-106a-5p levels were compared. The diagnostic and prognostic value of plasma miR-106a-5p for AHF was assessed with a receiver-operating characteristic curve. Results: Plasma miR-106a-5p was lowly expressed in AHF patients versus controls (0.53 ± 0.26 vs. 1.09 ± 0.46) and showed significant negative correlations with NT-proBNP and hs-CRP levels. Plasma miR-106a-5p level < 0.655 could assist in AHF diagnosis. Plasma miR-106a-5p levels were markedly lower in poor-prognosis AHF patients than in good-prognosis patients. Plasma miR-106a-5p level < 0.544 could assist in predicting poor prognosis in AHF patients. Conclusion: Plasma miR-106a-5p is downregulated in AHF patients and could assist in diagnosis and poor prognosis prediction of AHF. [ABSTRACT FROM AUTHOR]

Aim: Diagnosing and classifying heart failure (HF) in the oldest-old patients has technical and interpretation issues, especially in the acute setting. We assessed the usefulness of both N-terminal pro-brain natriuretic peptide (NT-proBNP) and lung ultrasound (LUS) for confirming HF diagnosis and predicting, among hospitalized HF patients, those with reduced ejection fraction (HFrEF). Methods: We performed a cross-sectional study on 148 consecutive patients aged ≥ 80 years admitted to our Internal Medicine and Geriatrics ward with at least one symptom/sign compatible with HF and NT-proBNP ≥ 125 pg/mL. We measured serum NT-proBNP levels and performed LUS and transthoracic echocardiography (TTE) on admission before diuretic therapy. We divided our cohort into three subgroups according to the left ventricular ejection fraction (LVEF): reduced (LVEF ≤ 40%), mildly-reduced (LVEF = 41-49%) and preserved (LVEF ≥ 50%). Results: The mean age was 88±5 years. Male prevalence was 42%. Patients with HFrEF were 19%. Clinical features and laboratory parameters did not differ between the three subgroups, except for higher NT-proBNP in HFrEF patients, which also had a higher number of total B-lines and intercostal spaces of pleural effusion at LUS. Overall, NT-proBNP showed an inverse correlation with LVEF (r = -0.22, p = 0.007) and a direct correlation with age, total pulmonary B-lines, and intercostal spaces of pleural effusion. According to the ROCs, NT-proBNP levels, pulmonary B-lines and pleural effusion extension were poorly predictive for HFrEF. The best-performing cut-offs were 9531 pg/mL for NT-proBNP (SP 0.70, SE 0.50), 13 for total B-lines (SP 0.69, SE 0.85) and one intercostal space for pleural effusion (SP 0.55, SE 0.89). Patients with admission NT-proBNP ≥ 9531 pg/mL had a 2-fold higher risk for HFrEF (OR 2.5, 95% CI 1.3-4.9), while we did not find any association for total B-lines ≥ 13 or pleural effusion ≥ 1 intercostal space with HFrEF. A significant association with HFrEF emerged for the combination of NT-proBNP ≥ 9531 pg/mL, total B-lines ≥ 13 and intercostal spaces of pleural effusion ≥ 1 (adjusted OR 4.3, 95% CI 1.5-12.9). Conclusions: Although NT-proBNP and LUS help diagnose HF, their accuracy in discriminating HFrEF from non-HFrEF was poor in our real-life clinical study on oldest-old hospitalized patients, making the use of TTE still necessary to distinguish HF phenotypes in this peculiar setting. These data require confirmation in more extensive and longer prospective studies. [ABSTRACT FROM AUTHOR]

Aims: There is a lack of specific studies assessing the impact of natriuretic peptide monitoring in the post‐discharge management of patients with heart failure (HF) and preserved ejection fraction (HFpEF), throughout the vulnerable phase following acute HF hospitalization. The NICE study aims to assess the clinical benefit of incorporating N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) into the post‐discharge management of HFpEF patients. Methods and results: Individuals admitted with HFpEF (left ventricular ejection fraction >50%) were included in a multicentre randomized controlled study employing an open‐label design with event blinding (NCT02807168). Upon discharge, 157 patients were randomly allocated to either NT‐proBNP monitoring (n = 79) or no access to NT‐proBNP (control group, n = 78) during pre‐scheduled visits at 2, 4 and 12 weeks. Clinical endpoints were evaluated at 6 months. The primary endpoint of HF rehospitalizations occurred in 12.1% patients, without significant differences observed between the NT‐proBNP monitoring group (12.8%) and the control group (11.4%) (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.47–2.81, p = 0.760). Regarding secondary endpoints, the NT‐proBNP monitoring group demonstrated a significantly lower risk of death (1.3% vs. 10.1%; HR 0.12, 95% CI 0.02–0.98; p = 0.048), whereas non‐HF hospitalizations (12.8% vs. 19.0%, p = 0.171) and any adverse clinical event (26.9% vs. 36.7%, p = 0.17) did not reach statistical significance [Correction added on 29 April 2024, after first online publication: In the preceding sentence, "95% CI 0.02 ‐ 0.09" has been corrected to "95% CI 0.02 ‐ 0.98; p = 0.048" in this version.]. Awareness of NT‐proBNP levels were associated with higher doses of diuretics and renin–angiotensin system inhibitors (angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers) in the NT‐proBNP monitoring group. Conclusions: Post‐discharge monitoring of NT‐proBNP in HFpEF patients did not exhibit an association with reduced rates of HF hospitalization in this study. Nonetheless, it appears to enhance global clinical management by optimizing medical therapies and contributing to improved overall survival. [ABSTRACT FROM AUTHOR]

Purpose: In adults and fetuses, N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of cardiac failure and myocardial remodelling. We examined the effect of anemia and intrauterine transfusion (IUT) on NT-proBNP concentrations in fetuses with anemia and established gestational age-dependent reference values of a control group. Methods: We analyzed NT-proBNP levels in anemic fetuses that underwent serial intrauterine transfusions (IUT), focusing on different causes and severity of anemia and comparing the results to a non-anemic control group. Results: In the control group, the average NT-proBNP concentration was 1339 ± 639 pg/ml, decreasing significantly with increasing gestational age (R = − 74.04, T = − 3.65, p = 0.001). Subjects had significantly higher NT-proBNP concentrations before initiation of IUT therapy (p < 0.001), showing fetuses with parvovirus B19 (PVB19) infection having the highest concentrations. Hydropic fetuses also showed an increased NT-proBNP concentration compared to non-hydropic fetuses (p < 0.001). During the course of therapy, NT-proBNP concentration before subsequent IUT decreased significantly from pathologically high levels, while MoM-Hb and MoM-MCA-PSV remained pathological. Conclusion: NT-pro BNP levels in non-anemic fetuses are higher than in postnatal life, decreasing with ongoing pregnancy. Anemia is a hyperdynamic state and its severity correlates with circulating NT-proBNP levels. Highest concentrations occur in fetuses with hydrops and with PVB19 infection, respectively. Treatment by IUT leads to a normalisation of NT-proBNP concentrations, so the measurement of its levels may be useful in therapy monitoring. [ABSTRACT FROM AUTHOR]