Prognostic Value of BNP Reduction During Hospitalization in Patients With Acute Heart Failure

BackgroundPrognostication of patients discharged after acute heart failure (AHF) hospitalization remains challenging. Body weight (BW) reduction is often used as a surrogate marker of decongestion despite the paucity of evidence. We thought to test the hypothesis that B-type natriuretic peptide (BNP) reduction during hospitalization has independent prognostic value in AHF.Methods and ResultsWe studied the prognostic predictability of percentage BNP reduction achieved during hospitalization in patients from the REALITY-AHF study. Percentage BNP reduction was defined as (BNP on admission ? BNP at discharge) / BNP on admission × 100. The primary endpoint was 1-year all-cause death. In 1028 patients (age, 77 ± 13 years; 57% male; left ventricular ejection fraction, 47 ± 16%) with AHF, median BNP level at admission was 747 ng/L (interquartile range, 439–1367 ng/L) and median percentage BNP reduction was 62.5% (interquartile range, 36.5–78.5%). The smallest percentage BNP reduction quartile had more than 2-fold higher risk of all-cause death than the greatest quartile (23.0% vs 9.7%, P< .001). After adjusting for covariates including BNP at discharge, the percentage BNP reduction was significantly associated with all-cause death (hazard ratio 0.96, 95% confidence interval 0.93–0.99, P= .032), whereas percentage BW reduction was not. Percentage BNP reduction was more predictive in patients with heart failure with reduced ejection fraction than in those with preserved ejection fraction.ConclusionsThe prognostic value of percentage BNP reduction during hospitalization was superior to that of percentage BW reduction and was independent of other risk markers, including BNP at discharge.     

Correlation of biological aggressiveness assessed by <Superscript>11</Superscript>C-methionine PET and hypoxic burden assessed by <Superscript>18</Superscript>F-fluoromisonidazole PET in newly diagnosed glioblastoma

Purpose  

Glioblastoma multiforme (GBM) is characterized by tissue hypoxia associated with resistance to radiotherapy and chemotherapy. To clarify the biological link between hypoxia and tumour-induced neovascularization and tumour aggressiveness, we analysed detailed volumetric and spatial information of viable hypoxic tissue assessed by ¹⁸F-fluoromisonidazole (FMISO) PET relative to neovascularization in Gd-enhanced MRI and tumour aggressiveness by L-methyl-¹¹C-methionine (MET) PET in newly diagnosed GBMs.     

Interstitial pneumonitis associated with dasatinib: two case reports and literature review

Dasatinib has increasingly been used to treat chronic myeloid leukemia (CML), although interstitial pneumonitis has been found as a complication in large clinical trials. In the present study, 23 patients received dasatinib for CML between 2012 and 2017 at our institution, of whom 2 developed symptomatic interstitial pneumonitis. Notably, the first patient developed interstitial pneumonitis five years after initiating dasatinib. Interstitial pneumonitis should be considered as a complication in patients receiving dasatinib for CML, which may even occur after a long period of uncomplicated administration.     

A case of primary malignant lymphoma of the prostate

A 79-year-old man presented with a chief complaint of difficulty in urination. Digital rectal examination and transrectal ultrasonography showed an enlarged prostate. Holmium laser enucleation of the prostate (HoLEP) was performed. Histological findings revealed diffuse large B-cell lymphoma by immunohistochemical studies. Pelvic Lymph nodes were swollen on fluoro deoxygiucose-positron emission tomography examination. Therefore, the disease was classified into clinical stage II according to Ann Arbor's criteria. The patient achieved complete response after 6 cycles of combination chemotherapy with rituximab, pirarubicin, cyclophosphamide, vincristine, and prednisolone (R-THP-COP). Now, 1 year 8 months after the chemotherapy, he remains free of the disease.