N-terminal pro-B-type natriuretic peptide is associated with sudden cardiac death risk: the Cardiovascular Health Study.

Background: Sudden cardiac death (SCD), the cause of 250,000-450,000 deaths per year, is a major public health problem. The majority of those affected do not have a prior cardiovascular diagnosis. Elevated B-type natriuretic peptide levels have been associated with the risk of heart failure and mortality as well as with sudden death in women.

Post-discharge changes in NT-proBNP and quality of life after acute dyspnea hospitalization as predictors of one-year outcomes.

Aims: The association of serial NT-proBNP changes and poor quality of life (QOL) with progressive heart failure (HF) and clinical outcomes in emergency department dyspnea patients is poorly understood.

Methods And Results: The predictive value of changes in NT-proBNP and QOL (Minnesota Living with Heart Failure scale) from baseline to 30-day follow-up was examined for all-cause 1-year mortality and HF hospitalization. Patients with an initially elevated NT-proBNP (≥300 ng/L) which persisted at 30-days (no ≥25% decrease) were at high risk of death or HF hospitalization (HR=6.

Early and midterm hemodynamics after aortic valve bypass (apicoaortic conduit) surgery.

Background: Aortic valve bypass (AVB [apicoaortic conduit]) relieves aortic stenosis (AS) by connecting the apex of the left ventricle to the descending thoracic aorta with a valved conduit. AVB is performed through a small left thoracotomy, without cardiopulmonary bypass, aortic cross-clamping, cardiac arrest, or debridement of the native aortic valve. Little is known about hemodynamics, including ventricular performance, relative conduit blood flow, and progression of native AS after AVB.

Impact of increased body mass index on accuracy of B-type natriuretic peptide (BNP) and N-terminal proBNP for diagnosis of decompensated heart failure and prediction of all-cause mortality.

Background: BNP and N-terminal proBNP (NT-proBNP) concentrations may be depressed in patients with increased body mass index (BMI). Whether increased BMI affects accuracy of these biomarkers for diagnosing decompensated heart failure (HF) and predicting outcomes is unknown.

Methods: We measured BNP and NT-proBNP in 685 patients with possible decompensated HF in a free-living community population subdivided by BMI as obese, overweight, and normal weight.

Multi-center determination of galectin-3 assay performance characteristics: Anatomy of a novel assay for use in heart failure.

Background: Galectin-3 is a carbohydrate binding protein that plays many important regulatory roles in inflammation, immunity and cancer. Recent studies indicate that galectin-3 is a mediator of heart failure development and progression. Development of an improved assay for galectin-3 measurement was necessary for appropriate clinical assessment.

Dynamic cardiovascular risk assessment in elderly people. The role of repeated N-terminal pro-B-type natriuretic peptide testing.

Objectives: This study sought to determine whether serial measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in community-dwelling elderly people would provide additional prognostic information to that from traditional risk factors.

Background: Accurate cardiovascular risk stratification is challenging in elderly people.

Methods: NT-proBNP was measured at baseline and 2 to 3 years later in 2,975 community-dwelling older adults free of heart failure in the longitudinal CHS (Cardiovascular Health Study).

N-terminal pro-B-type natriuretic peptide is a major predictor of the development of atrial fibrillation: the Cardiovascular Health Study.

Background: Atrial fibrillation (AF), the most common cardiac rhythm abnormality, is associated with significant morbidity, mortality, and healthcare expenditures. Elevated B-type natriuretic peptide levels have been associated with the risk of heart failure, AF, and mortality.

Methods And Results: The relation between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and AF was studied in 5445 Cardiovascular Health Study participants with the use of relative risk regression for predicting prevalent AF and Cox proportional hazards for predicting incident AF.

Natriuretic peptides and echocardiography in acute dyspnoea: implication of elevated levels with normal systolic function.

Aims: Previous evaluations of natriuretic peptide (NP) levels in patients with acute dyspnoea presenting to the emergency department (ED) have selected only a minority of patients for echocardiography. We aimed to evaluate the association between NPs and more subtle echocardiographic findings and to assess the potential for NPs to provide additional prognostic information beyond that provided by echocardiography in 'all-comers' with acute dyspnoea.

Methods And Results: Prospective echocardiograms were performed on 338/412 patients presenting to the ED with acute dyspnoea.

Fibroblast growth factor 23 and left ventricular hypertrophy in chronic kidney disease.

Background: Fibroblast growth factor 23 (FGF-23) is a phosphorus-regulating hormone. In chronic kidney disease (CKD), circulating FGF-23 levels are markedly elevated and independently associated with mortality. Left ventricular hypertrophy and coronary artery calcification are potent risk factors for mortality in CKD, and FGFs have been implicated in the pathogenesis of both myocardial hypertrophy and atherosclerosis.

Lack of diagnostic and prognostic utility of circulating plasma myeloperoxidase concentrations in patients presenting with dyspnea.

Background: Plasma myeloperoxidase (MPO), an inflammatory biomarker, is associated with increased mortality in patients with acute coronary syndrome or chronic left ventricular systolic dysfunction. We sought to assess the diagnostic accuracy of MPO for acute decompensated heart failure (ADHF) and its prognostic value for patients with acute dyspnea.

Methods: In a prospective, observational study conducted in 5 US centers, 412 patients [mean (SD) age, 58 (14) years; 39% women] presenting with dyspnea to the emergency department were enrolled and followed for 1 year.

Understanding amino-terminal pro-B-type natriuretic peptide in obesity.

Concentrations of both B-type natriuretic peptide (BNP) and its amino-terminal cleavage fragment (NT-proBNP) are relatively lower among patients with a higher body mass index (BMI). Based on data at hand, this is probably related to reduced synthesis or secretion of the peptides, rather than increased clearance (which may play only a minor role in this context). Despite this fact, age-adjusted NT-proBNP cut points to "rule in" heart failure (HF) and age-independent cut points to "rule out" HF in patients with acute dyspnea are equally useful for obese and lean patients, and no adjustment of NT-proBNP thresholds for BMI is recommended.

Amino-terminal pro-B-type natriuretic peptide testing in renal disease.

Concentrations of amino-terminal pro-B-type natriuretic peptides (NT-proBNP) are typically higher in patients with chronic kidney disease (CKD) than in those without CKD. These elevated levels of NT-proBNP in patients with CKD do not simply reflect the reduced clearance of the peptide; rather, they largely reflect a true-positive finding, identifying the presence of heart disease in these patients, while similarly indicating prognosis as well. Although modestly stronger inverse correlations exist between renal function and NT-proBNP compared with B-type natriuretic peptide (BNP), the dependence of both peptides on renal clearance is similar.

Frequency and cause of cardiac troponin T elevation in chronic hemodialysis patients from study of cardiovascular magnetic resonance.

Cardiac troponin T level predicts a gradient risk for death in patients using hemodialysis. We used cardiovascular magnetic resonance (CMR) to determine whether an asymptomatic increase of troponin T in patients using hemodialysis is associated with subclinical myocardial infarction (MI). Twenty-six patients using long-term hemodialysis (49 +/- 12 years of age, 19 men, 8 diabetics) with left ventricular (LV) ejection fraction >40% and no known coronary artery disease were selected based on a low-risk troponin T level View Article and Find Full Text PDF

Impact of renal disease on natriuretic peptide testing for diagnosing decompensated heart failure and predicting mortality.

Background: Concomitant occurrence of kidney disease (KD) and heart failure (HF) is common and associated with poor outcomes. Natriuretic peptide studies have typically excluded many individuals with KD. We compared the accuracy of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) for diagnosing decompensated HF and predicting mortality across the spectrum of renal function.

Distribution of coronary artery disease and relation to mortality in asymptomatic hemodialysis patients.

Background: Long-term dialysis patients have a high incidence of myocardial infarction and cardiovascular death, but the incidence of coronary artery disease (CAD) in asymptomatic patients, distribution of coronary obstruction, and relationship between lesion location and mortality are unknown.

Methods: We studied 67 asymptomatic hemodialysis patients who volunteered for coronary angiography. Coronary stenoses of 50% or greater were documented, and the location of each within the proximal, midportion, or distal segment of the coronary vessel was recorded.

Strain-related regional alterations of calcium-handling proteins in myocardial remodeling.

Background: Cardiac remodeling has been shown to have deleterious effects at both the global and local levels. The objective of this study is to investigate the role of strain in the initiation of structural and functional changes of myocardial tissue and its relation to alteration of calcium-handling proteins during cardiac remodeling after myocardial infarction.

Methods: Sixteen sonomicrometry transducers were placed in the left ventricular free wall of 9 sheep to measure the regional strain in the infarct, adjacent, and remote myocardial regions.

N-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide for identifying coronary artery disease and left ventricular hypertrophy in ambulatory chronic kidney disease patients.

Elevated natriuretic peptide levels are common in patients with chronic kidney disease (CKD), as is the presence of coronary artery disease (CAD) and left ventricular hypertrophy (LVH). It was hypothesized that N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and B-type natriuretic peptide (BNP) levels could identify CAD and LVH in asymptomatic patients with CKD. Clinical, laboratory, and echocardiographic data were collected prospectively in 54 ambulatory patients with CKD not requiring dialysis.

The efficacy of real-time 3-dimensional echocardiography for right ventricular biopsy.

Background: In recipients of cardiac transplant, repetitive right ventricular (RV) biopsies can result in decreased sample quality as a consequence of fibrosis from oversampling specific locations. Real-time 3-dimensional echocardiography (RT3D) is a new imaging modality that may precisely guide bioptome placement and, therefore, is a potential alternative to fluoroscopy (Fl). We sought to determine if a RT3D-guided biopsy procedure would result in a comparable or decreased incidence of fibrosis versus Fl.

Adjunctive handgrip during dobutamine stress echocardiography: invasive assessment of myocardial oxygen consumption in humans.

Background: Adjunctive isometric exercise in the form of sustained submaximal handgrip (HG) is considered to increase the sensitivity of dobutamine stress echo (DSE) for detection of functionally significant coronary artery disease.

Hypothesis: The study was undertaken to quantify invasively the impact of HG in humans on hemodynamics and myocardial oxygen consumption (MVO2) during DSE.

Methods: An invasive hemodynamic evaluation was performed during DSE and with addition of adjunctive HG in 11 subjects.

N-terminal pro-B-type natriuretic peptide for predicting coronary disease and left ventricular hypertrophy in asymptomatic CKD not requiring dialysis.

Background: N-Terminal pro-B-type natriuretic peptide (NT-proBNP) level predicts underlying heart disease in the general population. However, because NT-proBNP clearance may depend on renal function, the significance of an elevated level in patients with chronic kidney disease (CKD) without cardiac symptoms is uncertain. We sought to determine whether there is an association between NT-proBNP level and coronary artery disease (CAD) and left ventricular hypertrophy (LVH) in this population.

Cardiac troponin T and C-reactive protein for predicting prognosis, coronary atherosclerosis, and cardiomyopathy in patients undergoing long-term hemodialysis.

Context: Cardiac troponin T (cTnT) and C-reactive protein (CRP) are prognostic markers in acute coronary syndromes. However, for patients with end-stage renal disease (ESRD) the ability of combinations of these markers to predict outcomes, and their association with cardiac pathology, are unclear.

Objective: To investigate the association between levels of cTnT and CRP and long-term risk of cardiac pathology and death in patients with ESRD.

Color M-mode flow propagation velocity versus conventional Doppler indices in the assessment of diastolic left ventricular function in patients on chronic hemodialysis.

Background And Objective: Color M-mode flow propagation velocity (Vp) has been reported as a preload-independent measure of diastolic function. To study the effects of loading conditions on diastolic function assessment in patients on chronic hemodialysis, we measured Vp and conventional Doppler indices pre- and posthemodialysis.

Methods: Twenty hemodialysis patients with normal systolic function underwent measurement of Vp, early filling velocity (E), its deceleration time (DT), atrial contraction velocity (A), isovolumic relaxation time (IVRT), and pulmonary atrial flow reversal velocity (PFR) pre- and posthemodialysis.