Obesity,Brain Natriuretic Peptide Levels and Mortality in Patients Hospitalized With Heart Failure and Preserved Left Ventricular Systolic Function

BackgroundAn inverse relationship between brain natriuretic peptide (BNP) levels and body mass index (BMI) has been described for patients with left ventricular (LV) systolic dysfunction. In this study, the association of BMI, BNP levels and mortality in patients hospitalized for heart failure with preserved LV systolic function (HFpLVF) was investigated.MethodsOne hundred fifty consecutive patients (98% men) who were hospitalized with HFpLVF and had BNP levels measured on admission were analyzed. Patients were divided into categories of BMI: normal (BMI < 25 kg/m²), overweight (BMI 25–29.9 kg/m²) and obese (BMI ≥ 30 kg/m²). Relevant clinical and echocardiographic characteristics and all-cause mortality were obtained through chart review.ResultsBNP levels were significantly lower in obese (median = 227 pg/mL) and overweight (median = 396 pg/mL) patients compared with those with normal BMI (median = 608 pg/mL, P = 0.003). Higher BMI predicted BNP levels of <100 pg/mL. Compared with patients with normal BMI, overweight and obese patients had a significantly lower risk of total mortality, even after adjusting for other clinical characteristics, including log-transformed BNP levels, atrial fibrillation, the use of beta-blockers at discharge, age, hemoglobin levels and the presence of pulmonary congestion on admission. Higher BNP levels also independently predicted mortality.ConclusionsAn inverse relationship between BMI and BNP levels exists in patients hospitalized with HFpLVF. Higher BMI is associated with lower mortality, whereas higher BNP levels predict higher mortality in male patients with HFpLVF. These findings should be confirmed in a larger multicenter setting.     

氮末端脑钠素前体评价急性心肌梗死后左心室功能及重构

目的:研究血浆氮末端脑钠素前体(NT-proBNP)对心肌梗死后近期左心室功能及重构评价的临床应用价值.方法:研究对象为61例首次确诊急性心肌梗死的患者(分为A组n=30,B组n=31)和20例正常人(对照组).所有患者于发病后第48～96小时采血测定血浆NT-proBNP水平,并行Killip分级及超声心动图检查.分析左心室功能及左心室容积参数与血浆NT-proBNP水平的关系.结果:急性心肌梗死患者的血浆NT-proBNP水平明显高于对照组.NT-proBNP水平与左心室收缩末容积指数呈正相关(r=0.5551,P<0.001),与同期左心室射血分数呈负相关(r=-0.5538,P<0.001).NT-proBNP＜235 pmol/L诊断左心室射血分数＞0.55的敏感性、特异性和准确性分别是84.6%、65.5%和77.7%.多元逐步回归法分析影响NT-proBNP的因素有Killip 分级,室壁节段运动指数.结论:急性心肌梗死后患者血浆NT-proBNP 浓度显著升高,血浆NT-proBNP水平与左心室壁受累范围和心功能分级之间存在相关.     

Anemia and Left Ventricular Hypertrophy With Renal Function Decline and Cardiovascular Events in Chronic Kidney Disease

BackgroundAnemia is a common complication in patients with chronic kidney disease (CKD), which may initiate or accelerate left ventricular hypertrophy (LVH). This study is designed to assess whether the coexistence of anemia and LvH is independently associated with the rate of renal function decline and increased cardiovascular events in patients with CKD stages 3 to 5.MethodsThis longitudinal study enrolled 415 patients, who were classified into 4 groups according to sex-specific median values of hemoglobin and with/without LVH. The change in renal function was measured by estimated glomerular filtration rate slope. Cardiovascular events were defined as cardiovascular death, hospitalization for unstable angina, nonfatal myocardial infarction, sustained ventricular arrhythmia, hospitalization for congestive heart failure, transient ischemia attack, and stroke. The relative risk of cardiovascular events was analyzed by Cox's regression method.ResultsThe estimated glomerular filtration rate slope was significantly lower in the group with lower hemoglobin and LVH than in the other groups (P = 0.031). In addition, patients with lower hemoglobin and LVH were independently associated with increased cardiovascular events (hazard ratio, 4.269; 95% confidence interval, 1.402–13.000; P = 0.011).ConclusionsOur findings showed that the coexistence of anemia and LVH was independently associated with faster renal function decline and poor cardiovascular outcomes in patients with CKD. Assessments of serum hemoglobin level and LVH by echocardiography may help identify a high-risk group of poor renal and cardiovascular prognosis in patients with CKD stages 3 to 5.     

Prognostic Utility of Anemia and Pro-B-Type Natriuretic Peptide in Patients With Nonischemic Dilated Cardiomyopathy and Normal Renal Function

BackgroundIdiopathic dilated cardiomyopathy frequently coexists with anemia and high plasma NT proBNP levels. However, the prognostic impact of these features on the disease course is uncertain, especially in patients with normal renal function.MethodsForty-seven patients with idiopathic dilated cardiomyopathy with sinus rhythm and normal renal function were prospectively followed for a mean 25 ± 18 months period. Clinical end points were death (sudden cardiac death and deaths because of worsening heart failure) and cardiac transplantation. Prognostic impact of NT proBNP levels, anemia, echocardiographic and clinical parameters on the clinical end points was evaluated with Kaplan-Meier survival analysis. Cut-off values of hemoglobin and plasma NT proBNP levels for predicting end points were determined by receiver operating curve analysis.ResultsTwenty-eight patients (59.6%) suffered clinical end points. The patients who suffered clinical end points were anemic (P = 0.002), had lower systolic (P < 0.003) and diastolic (P < 0.0001) blood pressures, and higher NYHA functional classes (P = 0.005), lower left ventricle ejection fractions (P = 0.003), higher E/A ratios (P = 0.001), shorter E-wave deceleration times (P = 0.001), isovolumetric relaxation times (P = 0.05) and pulmonary acceleration times (P = 0.004), and higher plasma NT proBNP levels (P < 0.0001). Anemic patients had more clinical end points (P = 0.002). In univariate analysis the prognostic predictors of life expectancy were log NT proBNP, anemia, NYHA functional class, systolic blood pressure, left ventricle ejection fraction, and E-wave deceleration time. However, multivariate analysis revealed only plasma NT proBNP as independent predictor of clinical end points.ConclusionTracking plasma NT proBNP levels is a useful strategy during routine follow-ups of patients with nonischemic dilated cardiomyopathy. Its predictive value for prognosis needs more evaluation in larger controlled studies. In addition, the importance of anemia in those patients needs more study.     

慢性心力衰竭患者脑钠肽水平与左心室质量指数相关性研究

目的:本文旨在研究脑钠肽(BNP)对慢性心力衰竭(CHF)的诊断价值和CHF患者血浆BNP水平与左心室质量指数的相关性.方法:选择65例CHF患者(CHF组,心功能Ⅲ～Ⅳ级)及48例健康体检者(正常对照组).采用酶联免疫吸附法测定两组血浆BNP水平;超声心动图测定左心室质量指数.并将CHF患者的血浆BNP水平与左心室质量指数作相关性分析.结果:CHF组的血浆BNP水平与左心室质量指数显著高于正常对照组(P均＜0.001);血浆BNP水平与左心室质量指数呈显著正相关(r=0.387,P＜0.01),取正常对照组BNP浓度的x 1.96s为正常上限值,BNP诊断CHF的敏感性为92%,特异性为93%.在CHF组,血浆BNP浓度在不同心功能分级之间也有显著差异(P＜0.01).结论:血浆BNP水平对于诊断CHF具有较高的敏感性和特异性,并且与左心室重量指数密切相关.     

The Association of Chronic Kidney Disease With Outcomes Following Percutaneous Left Atrial Appendage Closure

ObjectivesThe aim of this study was to investigate the associations of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with in-hospital and short-term outcomes using a large national database representative of contemporary clinical practice.BackgroundCKD and ESRD are associated with increased risk for stroke and bleeding in patients with atrial fibrillation on oral anticoagulation. Left atrial appendage closure (LAAC) may provide a reasonable alternative for these patients; however, the impact of CKD and ESRD on in-hospital and short-term outcomes following LAAC remain largely unknown.MethodsThe Nationwide Readmissions Database was used to identify LAAC procedures from 2016 to 2017 in patients with no CKD, CKD (stages I-V), and ESRD. Multivariable logistic regression models were used to assess in-hospital and short-term outcomes. The primary outcome was in-hospital mortality.ResultsOf 21,274 patients who underwent LAAC during the study period, 3,954 (18.6%) had CKD and 571 (2.7%) had ESRD. ESRD was associated with increased risk for in-hospital mortality compared with no CKD (3.3% vs 0.4%; adjusted odds ratio: 6.48; 95% confidence interval: 3.35-12.50; P < 0.001) and CKD (3.3% vs 0.5%; adjusted odds ratio: 11.43; 95% confidence interval: 4.77-27.39; P < 0.001). CKD was associated with increased risk for in-hospital acute kidney injury or hemodialysis and stroke or transient ischemic attack. ESRD and CKD were associated with increased readmissions extending to 90 days compared with no CKD, and ESRD was associated with increased readmissions compared with CKD. There was no difference with respect to other in-hospital outcomes.ConclusionsESRD is associated with higher in-hospital mortality, and CKD is associated with higher rates of stroke or transient ischemic attack in patients undergoing LAAC. Further research is needed to assess the impact of CKD and ESRD on long-term outcomes in these patients.     

Impact of Bariatric Surgery on N-Terminal Fragment of the Prohormone Brain Natriuretic Peptide and Left Ventricular Diastolic Function

Background

Obesity is often associated with left ventricular (LV) diastolic dysfunction (DD). Elevated N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) is considered a biomarker of LV dysfunction. Weight loss induced by bariatric surgery may improve LV DD, but conflicting results regarding NT-proBNP levels have been reported. Our objective was to determine the impact of bariatric surgery–induced weight loss on NT-proBNP levels and LV DD.

Methods

Seventy (70) patients were evaluated before and 6 and 12 months following a biliopancreatic diversion with duodenal switch (BPD-DS), and 33 subjects were followed as controls at baseline and 6 and 12 months later. Blood was collected for NT-proBNP measurement, and LV diastolic function was assessed with echocardiography.

Results

Among the 103 severely obese patients, 82% presented some degree of LV DD. Systolic function was preserved in all subjects. Along with significant weight loss, LV DD significantly improved (P < 0.001) in the BPD-DS group, whereas there was no change in the control group. NT-proBNP levels decreased over time in the control group (P = 0.016) and increased in subjects following BPD-DS (baseline vs 6-month vs 12-month follow-up: 51.8 ± 62.8 vs 132.0 ± 112.9 vs 143.3 ± 120.4 pg/mL; P < 0.001). The most significant associations with changes in NT-proBNP levels were improvements in the metabolic profile.

Conclusions

In severely obese patients, NT-proBNP levels decrease with sustained obesity for 1 year. Despite significant improvements in LV DD following bariatric surgery, NT-proBNP levels increase. These results suggest that monitoring NT-proBNP levels following bariatric surgery may be misleading regarding LV DD and symptoms of dyspnea.     

Prognostic Value of N-Terminal Pro–B-Type Natriuretic Peptide in Elderly Patients With Valvular Heart Disease

BackgroundN-terminal pro–B-type natriuretic peptide (NT-proBNP) may reflect early prognosis in patients with valvular heart disease (VHD).ObjectivesThe aim of this study was to examine the association between NT-proBNP and mortality in elderly patients with VHD.MethodsA total of 5,983 elderly patients (age ≥60 years) with moderate or severe VHD underwent echocardiography and NT-proBNP measurement. VHD examined included aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid regurgitation, and multivalvular heart disease. NT-proBNP ratio was defined as measured NT-proBNP relative to the maximal normal values specific to age and sex. Disease-specific thresholds were defined on the basis of penalized splines and maximally selected rank statistics.ResultsThe cohort had a mean age of 71.1 ± 7.6 years. At 1-year follow-up, 561 deaths (9.4%) had occurred. In penalized splines, relative hazards showed a monotonic increase with greater NT-proBNP ratio for death with different VHDs (p < 0.001 for all) except mitral stenosis. Higher NT-proBNP ratio, categorized by disease-specific thresholds, was independently associated with mortality (overall adjusted hazard ratio: 1.99; 95% confidence interval: 1.76 to 2.24; p < 0.001). Different subtypes of VHD all incurred excess mortality with elevated NT-proBNP ratio, with the strongest association detected for aortic stenosis (adjusted hazard ratio: 10.5; 95% confidence interval: 3.9 to 28.27; p < 0.001). The addition of NT-proBNP ratio to the prediction algorithm including traditional risk factors improved outcome prediction (overall net reclassification index = 0.28; 95% CI: 0.24 to 0.34; p < 0.001; likelihood ratio test p < 0.001). Results remained consistent in patients under medical care, with normal left ventricular ejection fractions, and with primary VHD.ConclusionsNT-proBNP provides incremental prognostic information for mortality in various VHDs. It could aid in risk stratification as a pragmatic and versatile biomarker in elderly patients.