N‐terminal pro‐B‐type natriuretic peptide: an independent marker for coronary artery disease in asymptomatic diabetic patients

Aims To determine whether plasma N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) levels, a marker for cardiac failure and potentially for the severity of coronary artery disease (CAD), predicts silent myocardial ischaemia (SMI) and silent CAD in asymptomatic high‐risk diabetic patients. Methods Five hundred and seventeen asymptomatic diabetic patients with ≥ 1 additional cardiovascular risk factor but without heart failure were prospectively screened between 1998 and 2008 for SMI, defined as an abnormal stress myocardial scintigraphy, and subsequently for significant (> 70%) angiographic CAD. The 323 patients with interpretable echocardiography and for whom NT‐proBNP was measured were included in this analysis. Results SMI was found in 108 (33.4%) patients, 39 of whom had CAD. NT‐proBNP was higher in the patients with CAD than in the patients without CAD [45.0 (1–3199) vs. 20.0 (1–1640) pg/ml; P < 0.0001 median (range)], even after adjustment for confounding factors: age, gender, body mass index, glycated haemoglobin (HbA_1c), retinopathy, nephropathy, hypertension, echocardiographic parameters (P < 0.05). NT‐proBNP in the third tertile (≥ 38 pg/ml) predicted CAD with a sensitivity of 59% and a specificity of 67%. In a multiple logistic regression analysis including NT‐proBNP ≥ 38 pg/ml, age, body mass index, gender, HbA_1c, hypertension, retinopathy, nephropathy, peripheral occlusive arterial disease, left ventricular systolic dysfunction, dilatation and hypertrophy and Type 1 transmitral flow, NT‐proBNP ≥ 38 pg/ml was the only significant independent predictor of silent CAD [odds ratio (OR) 3.1 (95% confidence interval 1.3–7.6), P = 0.015]. Conclusions NT‐proBNP measurement helps to better define asymptomatic diabetic patients with an increased likelihood for CAD, independently of cardiac function and structure.     

Addition of Novel Biomarkers for Predicting All‐Cause and Cardiovascular Mortality in Prevalent Hemodialysis Patients

Novel biomarkers might improve the prediction of mortality in hemodialysis (HD) patients. We simultaneously measured the levels of conventional and novel biomarkers [serum N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), intact fibroblast growth factor‐23 (FGF23), β2‐microglobulin (β2MG), cystatin C, and high‐sensitivity C‐reactive protein (hsCRP)] in 307 prevalent Japanese HD patients. There were 66 all‐cause deaths, and 25 cardiovascular (CV) deaths during 2 years, which were assessed using Cox models and concordance (C)‐statistics. The addition of NT‐proBNP alone (P < 0.05) or NT‐proBNP, hsCRP, and β2MG as a panel (C‐statistics: 0.834 vs. 0.776, P < 0.01) to a conventional risk model composed of age, diabetes, and the serum albumin level significantly improved the prediction of 2‐year all‐cause mortality, and the addition of NT‐proBNP and hsCRP as a panel to a conventional risk model composed of age significantly improved the prediction of 2‐year CV mortality (P < 0.05) in Japanese prevalent HD patients. Neither FGF23 nor cystatin C improved mortality prediction.     

Predictive value of predischarge spectral tissue doppler echocardiography and n-terminal pro-B-type natriuretic peptide in patients hospitalized with acute heart failure

Background: Admission for an acute heart failure (HF) confers an extremely poor prognosis. We aimed at finding out whether simultaneous assessment of multiple plasma‐based biomarkers and Doppler echocardiography could provide complementary information and thus enable clinicians to stratify risk more effectively among patients hospitalized with acute HF; hence, untoward events after discharge avoided. Methods: A comprehensive echocardiographic study and measurements of cardiac troponin I (cTnI), N‐terminal pro‐B‐type natriuretic protein (NT‐proBNP), and high‐sensitivity C‐reactive protein (hsCRP) were conducted in 87 patients with symptomatic de novo acute HF or decompensation of chronic HF. Major adverse cardiac events (MACE) regarding cardiac death or hospitalization with worsening HF during a median follow‐up period of 191 days were determined. Results: According to the univariate analysis, echocardiographic variables left atrial volume, left atrial volume index, pulmonary artery systolic pressure, E/E′ ratio, and the concentrations of NT‐proBNP were significantly related to clinical outcomes (all P‐values < 0.05). Cox proportional hazard analysis identified two independent prognostic predictors of MACE: E/E′ ratio and NT‐proBNP. Moreover, the combining of plasma level of NT‐proBNP with E/E′ ratio provided independent and additional prognostic value in identifying high‐risk acute HF patients. Conclusions: These findings reinforce the necessity of combining the heart hemodynamic variable E/E′ ratio and plasma‐based neurohormonal biomarker NT‐proBNP when clinicians attempt to define the individual risk of patients hospitalized with acute HF. (Echocardiography 2011;28:303‐310)     

Plasma amino‐terminal pro‐brain natriuretic peptide levels in subjects presenting to the Emergency Department with suspected acute coronary syndrome: possible role in selecting patients for follow up?

Background: Plasma amino‐terminal pro‐brain natriuretic peptide (NT‐proBNP) level is a sensitive and specific indicator of cardiac dysfunction. Aim: To determine whether plasma NT‐proBNP level is elevated at the time of presentation with acute coronary syndrome (ACS) and whether it may assist in the diagnosis of heart failure and myocardial ischaemia in the Emergency Department. Methods: Plasma NT‐proBNP levels were measured prospectively in 201 unselected presentations to the Emergency Department with suspected ACS where cardiac injury markers were requested by clinicians as part of routine assessment. NT‐proBNP levels were correlated with clinical, electrocardiogram (ECG), biochemical and radiological findings. Results: Elevated NT‐proBNP level detected heart failure with high sensitivity (95–96%). Among patients without heart failure, NT‐proBNP levels were increased more frequently in patients with previously diagnosed ischaemic heart disease. Elevated NT‐proBNP level predicted cardiomegaly and a cardiac cause of presentation. However, the NT‐proBNP level was not associated with ECG or biochemical markers of myocardial ischaemia, and only one‐third of patients with ACS showed an increase of 40% or more in NT‐proBNP level at repeat measurement of cardiac injury markers 5 h after presentation. Conclusions: Although elevated NT‐proBNP level detected heart failure with high sensitivity, NT‐proBNP level did not assist in the diagnosis of acute myocardial ischaemia. These findings indicate that the major determinant of elevated NT‐proBNP level on presentation with suspected ACS was underlying cardiac dysfunction rather than acute myocardial ischaemia. This suggests that NT‐proBNP measurement in patients with a suspected cardiac reason for presentation to the Emergency Department may identify a previously unrecognized group of patients without acute ischaemia who may nevertheless benefit from further investigation of cardiac function. (Intern Med J 2001; 31: 211–219)     

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

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

N-terminal proB-type natriuretic peptide levels aid the diagnosis of left ventricular dysfunction in patients with severe acute exacerbations of chronic obstructive pulmonary disease and renal dysfunction

Background and objective: The aim of this study was to assess the performance of N‐terminal proB‐type natriuretic peptide (NT‐proBNP) levels for the diagnosis of left ventricular dysfunction in patients with severe acute exacerbations of chronic obstructive pulmonary disease (COPD) and renal dysfunction. Methods: NT‐proBNP levels at admission were measured in consecutive patients admitted to two participating intensive care units with acute exacerbations of COPD. Left ventricular dysfunction was assessed on the basis of clinical and echocardiographic criteria. The performance of NT‐proBNP levels was evaluated in patients with or without renal dysfunction. Results: Among the 120 patients included in the study, 70 had impaired renal function, defined as a glomerular filtration rate of <90 mL/min/1.73 m². NT‐proBNP levels were inversely correlated with glomerular filtration rate (Spearman's correlation coefficient = ?0.457, P < 0.001). Overall, left ventricular dysfunction was diagnosed in 58 patients (48.3%). Median NT‐proBNP levels were significantly higher in these patients, irrespective of whether their renal function was normal (3313 (interquartile range (IQR) 4603) vs 337 (IQR 695) pg/mL, P < 0.001) or impaired (5692 (IQR 10714) vs 887 (IQR 1165) pg/mL, P < 0.001). The areas under the receiver operating characteristic curves were 0.87 and 0.78, respectively. The threshold NT‐proBNP value with the highest diagnostic accuracy was greater in the setting of renal dysfunction (2000 pg/mL; sensitivity 71%, specificity 82%, compared with 1000 pg/mL in patients with normal renal function; sensitivity 94%, specificity 82%). Multivariate analysis showed that left ventricular dysfunction and glomerular filtration rate were independently associated with elevated NT‐proBNP levels. Conclusions: NT‐proBNP remains an accurate biomarker for the diagnosis of left ventricular dysfunction associated with acute exacerbations of COPD. Threshold values of NT‐proBNP were higher in patients with impaired renal function than in those with normal renal function.     

Relation between NT-proBNP levels, iron overload, and early stage of myocardial dysfunction in β-thalassemia major patients

Background: Heart failure (HF) secondary to myocardial iron loading remains the leading cause of death in β‐thalassemia major (β‐TM) patients. The early diagnosis and treatment of HF in these patients is related to survival. We aimed to evaluate myocardial performance using conventional and tissue Doppler echocardiography and its relation to plasma NT‐proBNP levels and iron overload indices in β‐TM patients with preserved systolic function. Methods: The study population included 49 β‐TM patients (24.0 ± 4.2 years) and 48 age‐matched healthy controls. Doppler‐echocardiographic study was performed and blood samples for NT‐proBNP measurements were drawn on the third day following blood transfusion. Patients were divided as group‐1, without diastolic dysfunction: E/E′ ratio < 9 and group‐2, with suspected diastolic dysfunction: E/E′ ratio ≥ 9. Results: NT‐proBNP levels and E/E′ ratio were increased in patients compared with controls (P < 0.001 and P < 0.001) but did not correlate with each other. A strong positive correlation was detected between NT‐proBNP levels and mean ferritin levels in β‐TM patients (r_s= 0.939; P < 0.001). Median NT‐proBNP levels were significantly higher in group‐1 in comparison to controls [51.2 (41.51–113.5) vs 30.1 (17.97–68.16) ng/mL, P < 0.01]. NT‐proBNP levels were also increased in group‐2 in comparison to group‐1 but this increase was not statistically significant. Conclusion: NT‐proBNP secretion begins in the early phase of the disease before the increase in diastolic pressure becomes overt. While there was a strong correlation between the plasma NT‐proBNP levels and iron overload, there was no correlation between NT‐proBNP levels and diastolic dysfunction parameters in patients in the third decade of life. (Echocardiography 2012;29:318‐325)     

N-terminal pro-B-type natriuretic peptide is associated with severity of the coronary lesions in unstable angina patients with preserved left ventricular function

Objectives: To evaluate the association between N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) values and the severity of coronary lesions at angiography in unstable angina patients with preserved left ventricular function. Methods: A total of 133 patients with primary diagnosis of unstable angina were enrolled into this study. NT‐proBNP level was determined before the angiography and Gensini score, a measurement of extent of myocardial ischemia, was calculated after the angiography by experienced cardiologists. Patients with >50% stenosis of the left main or 75% stenosis of one or more coronary branches with diameter >2 mm were defined as “angiography positive” and turned to percutaneous coronary intervention. Results: There was a significant difference of circulating NT‐proBNP level between the angiography positive and negative groups and the median NT‐proBNP values were 367.5 pg/mL and 112 pg/mL, respectively (P < 0.001). A significant correlation was observed between log NT‐proBNP and log Gensini score (P < 0.001). NT‐proBNP level was a predictor of angiography positive result and the area under the receiver operating characteristic curve was 0.776 (95% CI 0.693–0.858). Conclusions: NT‐proBNP level was found to be higher with the severity of myocardial ischemia. However, the ability of NT‐proBNP to identify clinically significant angiographic lesions was moderate. (J Interven Cardiol 2012;25:126–131)     

Association of High‐Sensitivity Cardiac Troponin T and N‐Terminal Pro–Brain‐Type Natriuretic Peptide With Left Ventricular Structure: J‐HOP Study

Although both high‐sensitivity cardiac troponin T (Hs‐cTnT) and N‐terminal pro–brain‐type natriuretic peptide (NT‐proBNP) levels are higher among patients with cardiac structural abnormalities than among those with apparently normal hearts, there is considerable overlap between the groups. The authors evaluated 1336 patients who had ≥1 cardiovascular risk factors, underwent echocardiography, and had Hs‐cTnT and NT‐proBNP measured and excluded patients with left ventricular (LV) dysfunction. The patients in the highest Hs‐cTnT category in quintiles had an increased likelihood of abnormal relative wall thickness compared with those in the lowest category (odds ratio, 1.66; 95% confidence interval, 1.17–2.36; P<.01). However, no such association was found in the category of NT‐proBNP. The patients in the highest NT‐proBNP category had an increased likelihood of abnormal LV diastolic dimension/body surface area compared with those in the lowest category (odds ratio, 2.11; 95% confidence interval, 1.17–3.79; P<.05). However, no such association was found in the category of Hs‐cTnT. The data suggest that the measurement of Hs‐cTnT and NT‐proBNP might provide information on cardiac structural abnormalities.     

Serum N-terminal pro-B-type natriuretic peptide levels at the time of hospital admission predict of microvascular obstructions after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction

Background: Significant microvascular obstruction (MVO) during primary percutaneous coronary intervention (PCI) may suggest severe myocardial damage. The predictive value of N‐terminal pro‐B‐type natriuretic peptide levels (NT‐proBNP) for MVO has not been previously evaluated. Hypothesis: The purpose of the study was to determine whether NT‐proBNP levels measured upon hospital admission of ST‐segment elevation myocardial infarction (STEMI) patients receiving primary PCI have predictive value for MVO. Methods: NT‐proBNP levels were obtained upon admission to the emergency department, for 41 acute STEMI patients. Cardiac contrast‐enhanced magnetic resonance imaging (CE‐MRI) was performed within 4 days after PCI. The optimal cut‐off value to predict grade 3 MVO was determined using a receiver operating characteristic (ROC) curve. Multivariate regression analysis was performed to determine predictors for grade 3 MVO. Results: MVO grade correlated with left ventricular ejection fraction (LVEF; r =?0.383, P = 0.013), peak serum creatine kinase MB iso‐enzyme (CK‐MB; r = 0.470, P = 0.002), and NT‐proBNP levels (r = 0.357, P = 0.022). The optimal cut‐off value to predict grade 3 MVO was an NT‐proBNP level of ≥80 pg/mL. Multivariate regression analysis, including LVEF, peak CK‐MB, and an NT‐proBNP ≥80 pg/mL revealed that only an NT‐proBNP ≥80 pg/mL was an independent factor related to grade 3 MVO. Conclusion: NT‐proBNP levels upon hospital admission have a predictive value for MVOs. Further study is needed to determine if protective treatment strategies are warranted in STEMI patients with high NT‐proBNP levels at presentation. (J Interven Cardiol 2011;24:34–41)     

N‐terminal pro–brain natriuretic peptide as a diagnostic marker of early pulmonary artery hypertension in patients with systemic sclerosis and effects of calcium‐channel blockers

Objective

To evaluate N‐terminal pro–brain natriuretic peptide (NT‐proBNP) as a marker of early pulmonary artery hypertension (PAH) and to study changes in the levels of this marker following treatment with dihydropyridine‐type calcium‐channel blocker (DTCCB) in patients with systemic sclerosis (SSc).

Methods

We evaluated 40 consecutive SSc patients who had been hospitalized for followup care (mean ± SD age 56 ± 11 years and mean ± SD duration of cutaneous disease 9 ± 9 years; 27 with limited cutaneous and 13 with diffuse cutaneous disease) but who had no clinical symptoms of heart failure and had a normal left ventricular ejection fraction. At baseline, 10 patients had PAH, defined as a systolic pulmonary artery pressure (sPAP) >40 mm Hg, as measured by echocardiography. Levels of NT‐proBNP were determined at baseline (after discontinuation of DTCCB treatment for 72 hours), after taking 3 doses of DTCCB following treatment reinitiation (assessment 1), and after 6–9 months of continuous DTCCB treatment (assessment 2) in the 20 patients who attended regular appointments (including the 10 patients with PAH at baseline).

Results

At baseline, 13 patients had high NT‐proBNP values for their ages. High NT‐proBNP levels identified patients with PAH with a sensitivity of 90%, a specificity of 90.3%, a positive predictive value of 69.2%, and a negative predictive value of 96%. The NT‐proBNP level correlated with the sPAP (r = 0.44; P = 0.006). By assessment 1, the number of patients with PAH and high levels of NT‐proBNP had decreased from 9 of 10 to 2 of 10 (P = 0.02). This decrease was partially sustained at assessment 2 (4 of 10 patients; P = 0.06).

Conclusion

NT‐proBNP is a useful biologic marker that can be used to diagnose early PAH in SSc patients without clinical heart failure. Measurement of NT‐proBNP may be valuable for the evaluation of treatment with DTCCB and vasodilators in patients with PAH.

     

NT‐proBNP as a marker of cardiopulmonary status in sickle cell anaemia in Africa

N‐terminal (NT) pro‐brain natriuretic peptide (proBNP) ≥160 ng/l has a 78% positive predictive value for pulmonary hypertension and is associated with increased mortality in US sickle cell disease patients, but the importance in sickle cell disease patients in Africa is not known. In a cross‐sectional study at Ahmadu Bello University Teaching Hospital, Shika‐Zaria, Nigeria, we studied 133 hydroxycarbamide‐naïve Nigerian sickle cell anaemia patients aged 18–52 years at steady‐state and 65 healthy controls. Twenty‐six percent of patients versus 5% of controls had NT‐proBNP ≥160 ng/l (P = 0·0006). By logistic regression among the patients, human immunodeficiency virus seropositivity, higher serum ferritin and lower haemoglobin or higher lactate dehydrogenase independently predicted elevated NT‐proBNP. After adjustment for haemoglobin concentration, elevated NT‐proBNP concentration was associated with an estimated 7·8‐fold increase in the odds of severe functional impairment, defined as an inability to walk more than 300 m in 6 min (95% confidence interval 1·5–32·6; P = 0·005). Similarly, elevated tricuspid regurgitation velocity was associated with an estimated 5·6‐fold increase in the odds of functional impairment (95% confidence interval 1·5–21·0; P = 0·011). In conclusion, NT‐proBNP elevation is common and is associated with markers of anaemia, inflammation and iron status and with severe functional impairment among sickle cell anaemia patients in Nigeria.     

B‐type Natriuretic Peptides in Acute Coronary Syndromes: Implications in an Aging Population

B‐type natriuretic peptide (BNP) and N‐terminal‐proBNP (NT‐proBNP) are increasingly recognized as prognostic markers in patients with acute coronary syndrome (ACS). The need for novel and more effective tools for risk assessment cannot be more emphasized than in older patients with ACS given their atypical presentation, multiple comorbidities, and higher risk for mortality and morbidity. Accurate interpretation of B‐type NP values in older patients with ACS, however, may be confounded by several aging‐related physiologic changes. Advanced age, reduction in body mass, and kidney function and anemia have been associated with higher BNP and NT‐proBNP concentrations, and may create challenges with interpreting NP levels in the elderly. This review highlights the need to better understand the physiology of BNP and NT‐proBNP in older individuals and their prognostic value in older patients with ACS. Clin. Cardiol. 2012 doi: 10.1002/clc.22035 Dr. de Lemos has received grant support from Roche Diagnostics and Abbott Diagnostics. The authors have no other funding, financial relationships, or conflicts of interest to disclose.     

N‐terminal fragment of the type‐B natriuretic peptide (NT‐proBNP) contributes to a simple new frailty score in patients with newly diagnosed multiple myeloma

Multiple myeloma (MM) patient frailty has been delineated primarily by age and ECOG performance score (PS) and recently by the IMWG frailty score based on functional status [Activity of Daily Living (ADL) and Instrumental‐ADL scores], comorbidities [Charlson‐comorbidity‐index (CCI)] and age. It was hypothesized that N‐terminal natriuretic peptide type B (NT‐proBNP) might be both a more convenient measure of frailty and a predictor of overall survival (OS). Three‐hundred and fifty‐one consecutive symptomatic MM patients who were seen at Mayo Clinic within 30 days of diagnosis and who had blood stored were eligible. Data from the first visit was abstracted and used to calculate an ADL, CCI, and measure the NT‐proBNP level. The best cutoff of NT‐proBNP predicting OS was 300 ng/L. Variables predictive for OS were ECOG‐PS, age, CCI, ADL, ISS, revised‐ISS, and NT‐proBNP. On multivariate analysis age ≥70, PS ≥2, and NT‐proBNP ≥300 were independent predictors of survival. Patients were assigned a score of 1 for each of these variables, creating stages I–IV with scores of 0–3 points, respectively. The median OS from diagnosis was not reached, 58, 28, and 18 months (P < 0.0001), respectively. This frailty risk schema was independent of initial therapy and the revised‐ISS. NT‐proBNP is a useful predictor of survival independent of age and PS. It is a widely available biomarker that could be added to the panel of laboratory tests of newly diagnosed MM patients and serve as a simple and objective tool of determining frailty in clinical practice. Am. J. Hematol. 91:1129–1134, 2016. © 2016 Wiley Periodicals, Inc.     

The predictive value and evolution of N-terminal pro-B-type natriuretic peptide levels following transcutaneous aortic valve implantation

Aims: We sought to define the predictive value and evolution of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) levels following transcutaneous aortic valve implantation (TAVI). Methods and Results: We investigated 91 consecutive patients who underwent TAVI (59 transfemoral [TF], 32 transapical [TA]) in our institution. The balloon‐expandable valve was implanted in 75 and the self‐expanding in 16 patients. The baseline (within 48 hours prior to procedure), early (24–74 hours), and late (3–12 months) postprocedural NT‐proBNP levels were determined. The mortality status of all patients was ascertained as of September 2010. The 30‐day and 1.3(mean)‐year mortality was 3% and 12% (2%, 9% in the TF and 6%, 19% in the TA group). Increased baseline (χ²= 5.9, P = 0.016) and early (χ²= 4.9, P = 0.028) NT‐proBNP levels were predictive of mortality. All decrements of the NT‐proBNP levels in the TF patients were significant (baseline 4,984 ± 8,106 vs. early 3,912 ± 6,551 pg/mL, P = 0.016; late 633 ± 606 pg/mL, P = 0.003). In contrast, there was a trend for the early levels to increase in the TA patients (6,423 ± 8,897 vs. 8,100 ± 10,178 pg/mL, P = 0.090), and a significant decline in the late levels as compared to baseline (1,704 ± 3,417 pg/mL, P = 0.005). Conclusion: NT‐proBNP levels are predictive of mortality following TAVI. There is a differential early evolution of their levels between the TF and TA patients and a significant decline later in both groups. (J Interven Cardiol 2011;24:462–469)     

慢性阻塞性肺疾病致右心衰竭 NT-proBNP 水平和 Tei 指数相关性

目的：探究COPD致右心衰竭N末端脑钠肽原（NT‐proBNP）水平和心肌做功（Tei）指数相关性，为医学临床提供参考。方法选取2013年9月至2015年9月我院收治的200例C O PD致右心衰竭患者作为观察组。选取同期200例COPD患者作为对照组。对比观察2组患者NT‐proBNP水平和Tei指数相关性。结果 Tei指数与年龄和心率等因素无明显的相关性；NT‐proBNP、Tei指数随着NYHA心功能分级级别的升高而升高（ F ＝6.319、5.003，P ＜0.05）；Tei指数与 NT‐proBNP水平呈正相关（ r ＝0.876，P ＜0.05）。结论 COPD致右心衰竭患者的NT‐proBNP水平和 Tei指数呈正相关，可以较好的检测患者的病情，因此值得在对患者的临床检查中进行应用和推广。     

Arterial stiffness in a muscular artery in women with longstanding rheumatoid arthritis compared with healthy controls and patients with traditional cardiovascular risk factors

Pulse wave velocity (PWV), a marker of arterial stiffness, reflects vascular dysfunction and is associated with cardiovascular risk. Rheumatoid arthritis (RA) is associated with profound changes in vascular function and premature death, mainly caused by cardiovascular diseases. The aim of this study was to investigate arterial stiffness in the brachial artery (a muscular type of artery) as measured by PWV in women with longstanding RA and to compare the results with healthy controls and to patients with traditional cardiovascular risk factors without RA. A total of 80 female participants underwent non-invasive measurement of PWV. Participants were allocated to one of three groups: patients with longstanding RA (disease duration >5 years) without traditional cardiovascular risk factors (n = 30), patients with traditional cardiovascular risk factors (n = 20) and healthy controls (n = 30). Patients and controls were matched for age. PWV was significantly higher in RA patients (8.6 ± 0.9 m/s) as compared with healthy controls (8.1 ± 0.7 m/s; P = 0.02). PWV was virtually the same in RA patients and patients who had traditional cardiovascular risk factors (8.6 ± 1.5 m/s; NS). PWV was also higher in this group as compared with healthy controls, but this difference did not reach statistical significance (NS). RA is associated with a higher PWV as compared with healthy controls and is comparable to patients with known traditional risk factors. This reflects vascular dysfunction in patients with RA.     

High levels of circulating N‐terminal pro‐brain natriuretic peptide in patients with hepatitis C

Summary. Many patients chronically infected by hepatitis C virus (HCV) experience symptoms like fatigue, dyspnea and reduced physical activity. However, in many patients, these symptoms are not proportional to the liver involvement and could resemble symptoms of chronic heart failure. To our knowledge, no study evaluated serum levels of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in a large series of patients with HCV chronic infection (HCV+). Serum NT‐proBNP was assayed in 50 patients HCV+ and in 50 sex‐ and age‐matched controls. HCV+ patients showed significantly higher mean NT‐proBNP level than controls (P = 0.001). By defining high NT‐proBNP level as a value higher than 125 pg/mL (the single cut‐off point for patient under 75 years of age), 34% HCV+ and 6% controls had high NT‐proBNP (Fisher exact test; P < 0.001). With a cut‐off point of 300 pg/mL (used to rule out chronic heart failure in patients under 75 years of age) 10% HCV+ and 0 controls had high NT‐proBNP (Fisher exact test; P = 0.056). With a cut‐off point of 900 pg/mL (used for ruling in chronic heart failure in patients with age 50–75) 8% HCV+ patients and 0 controls had high NT‐proBNP (Fisher exact test; P = 0.12). The study demonstrates high levels of circulating NT‐proBNP in HCV+ patients compared to healthy controls. The increase of NT‐proBNP may indicate the presence of a sub‐clinical cardiac dysfunction. Further prospective studies quantifying these symptoms in correlation with echocardiography are needed to confirm this association.     

A multimarker risk stratification approach to non-ST elevation acute coronary syndrome: implications of troponin T, CRP, NT pro-BNP and fibrin D-dimer levels

Abstract. Tello‐Montoliu A, Marín F, Roldán V, Mainar L, López MT, Sogorb F, Vicente V, Lip GYH (Hospital General Universitario, Alicante; Hospital Morales Meseguer, Murcia; Hospital de Requena, Valencia; Hospital General Universitario, Alicante, Spain and City Hospital, Birmingham, UK). A multimarker risk stratification approach to non‐ST elevation acute coronary syndrome: implications of troponin T, CRP, NT pro‐BNP and fibrin D‐dimer levels. J Intern Med 2007; 262 : 651–658. Introduction. Biomarkers have emerged as interesting predictors of risk in non‐ST elevation acute coronary syndromes (non‐ST ACS). The aim of this study was to define the utility of the combined measurement of troponin T (TnT), C‐reactive protein (CRP), NT pro‐brain natriuretic peptide (NT pro‐BNP) and D‐dimer as biomarkers to predict adverse events. Methods. We included 358 consecutive patients admitted in two hospitals for non‐ST ACS. Baseline measurements of TnT (associated with myocardial injury, positive, if ≥0.1ng mL^?1), CRP (a marker of inflammation), NT‐proBNP (associated with left ventricular (dys)function) and fibrin D‐dimer (and index of thrombogenesis) were performed. A positive CRP, NT‐proBNP and D‐dimer test was considered upper than the 75th percentile of our population. The risk for major events (death, new ACS, revascularization and heart failure) at 6 months’ follow‐up was analysed. Results. Troponin T, NT pro‐BNP and CRP were predictors of adverse events in the multivariate analysis [hazards ratio (HR): 2.00 (1.30–3.07), P = 0.0016; HR: 2.27 (1.47–3.50), P = 0.0002; HR: 1.90 (1.24–2.92), P = 0.0034 respectively], but not D‐dimer levels [HR: 1.26 (0.79–2.02), P = 0.337). After adjusting for baseline characteristics and electrocardiographic changes, multimarker risk approach was associated with adverse events at 6 months, especially with the presence of three positive biomarkers [HR 2.80 (95%CI 1.68–4.68), P < 0.001]. When we divided patients by risk groups [Thrombolysis in Myocardial Infarction (TIMI) risk score], patients with two or three elevated biomarkers had higher event rates [HR 2.59 (95% CI 1.37–4.91), P = 0.004]. Conclusion. A multimarker approach based on TnT, CRP and NT‐proBNP provides added information to the TIMI risk score in terms of ACS prognosis at 6 months, with a worse outcome for those with two or three elevated biomarkers.     

Reduced arterial elasticity in rheumatoid arthritis and the relationship to vascular disease risk factors and inflammation

OBJECTIVE: Rheumatoid arthritis (RA) is associated with increased rates of cardiovascular disease. Reduced small artery elasticity (SAE) and large artery elasticity (LAE) and increased systemic vascular resistance (SVR) have been found in other high-risk groups. In the present study, we sought to determine whether arterial elasticity was reduced and SVR was increased in RA patients compared with controls matched for coronary artery disease (CAD) status, and to relate the results to vascular disease risk factors, including measures of inflammation. METHODS: Arterial elasticity was assessed by pulse wave analysis in RA patients with (n = 15) and without (n = 38) CAD, and in controls matched 1:1 for age, sex, and CAD status. Vascular risk factors, including high-sensitivity C-reactive protein (hsCRP), soluble vascular cell adhesion molecule 1 (sVCAM-1), and serum amyloid A (SAA) levels, were assessed. RESULTS: SAE and LAE were significantly lower and SVR was significantly higher in RA patients than in controls. RA patients also had higher levels of hsCRP, SAA, and sVCAM-1. SAE and LAE values were inversely correlated with markers of inflammation. Associations of SAE and LAE with RA were independent of conventional risk factors, but were dependent on markers of inflammation. CONCLUSION: Vascular function is abnormal in RA, with reduced SAE and LAE and increased SVR relative to controls. Arterial elasticity is inversely associated with measures of inflammation. These measures may be clinically useful in the detection and monitoring of vascular disease in RA.