Amino-terminal Pro-B-Type Natriuretic Peptide Among Patients Living With Both Human Immunodeficiency Virus and Heart Failure

Abstract

Background Among persons living with human immunodeficiency virus (PHIV), incident heart failure (HF) rates are increased and outcomes are worse; however, the role of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations among PHIV with HF has not been characterized. Methods Patients were derived from a registry of those hospitalized with HF at an academic center in a calender year. We compared the NT-proBNP concentrations and the changes in NT-proBNP levels between PHIV with HF and uninfected controls with HF. Results Among 2578 patients with HF, there were 434 PHIV; 90% were prescribed antiretroviral therapy and 62% were virally suppressed. As compared to controls, PHIV had higher admission (3822 [IQR, 2413–7784] pg/ml vs 5546 [IQR, 3257–8792] pg/ml, respectively; P < .001), higher discharge (1922 [IQR, 1045–4652] pg/ml vs 3372 [IQR, 1553–5452] pg/ml, respectively; P < .001), and lower admission-to-discharge changes in NT-proBNP levels (32 vs 48%, respectively; P = .007). Similar findings were noted after stratifying based on left ventricular ejection fraction (LVEF). In a multivariate analysis, cocaine use, a lower LVEF, a higher NYHA class, a higher viral load (VL), and a lower CD4 count were associated with higher NT-proBNP concentrations. In follow-up, among PHIV, a higher admission NT-proBNP concentration was associated with increased cardiovascular mortality (first tertile, 11.5; second tertile, 20; third tertile, 44%; P < .001). Among PHIV, each doubling of NT-proBNP was associated with a 19% increased risk of death. However, among patients living without HIV, each doubling was associated with a 27% increased risk; this difference was attenuated among PHIV with lower VLs and higher CD4 counts. Conclusions PHIV with HF had higher admission and discharge NT-proBNP levels, and less change in NT-proBNP concentrations. Among PHIV, VLs and CD4 counts were associated with NT-proBNP concentrations; in follow-up, higher NT-proBNP levels among PHIV were associated with cardiovascular mortality.

The burden and natural history of cardiac pathology at TB diagnosis in a high-HIV prevalence district in Zambia: protocol for the TB-Heart study

“…To our knowledge, this is the first observational study to systematically establish the prevalence of and associations between cardiac pathology and newly-diagnosed PTB. We will use a range of modalities including state-ofthe-art biochemical profiling of cardiac injury and stretch supplemented with non-invasive imaging of the myocardium by ultrasound [6,19,[32][33][34]. Our study also evaluates the role of point-of-care cardiac ultrasound -with particular relevance to low resource settings -to demonstrate its potential as a screening tool for cardiac pathology among participants with PTB [35].…”

The burden and natural history of cardiac pathology at TB diagnosis in a high-HIV prevalence district in Zambia: protocol for the TB-Heart study

“…We will use a range of modalities including state-of-the-art biochemical pro ling of cardiac injury and stretch supplemented with noninvasive imaging of the myocardium by ultrasound. (6,19,(32)(33)(34) Our study also evaluates the role of point-of-care cardiac ultrasound -with particular relevance to low resource settings -to demonstrate its potential as a screening tool for cardiac pathology among participants with PTB. (35) We expect that our initial ndings may result in future studies exploring 1) mechanistic relationships between PTB and cardiac pathology using advanced cardiac imaging techniques such as cardiac magnetic resonance imaging (CMR) and positron-emission tomography (PET), 2) exploratory immunology studies to provide further evidence as to whether a dose-dependent relationship exists between prevalent cardiac pathology and PTB disease, 3) observational cohort studies to evaluate the impact of prevalent cardiac pathology on short and long-term outcomes in TB disease and future cardiovascular disease risk, and 4) intervention studies to explore the added value of anti-in ammatory medication to reduce the burden of TB-associated cardiac sequelae.…”

Heart failure in human immunodeficiency virus-infected patients

“…Ограничениями проведенного исследования являются малая выборка больных с ВИЧ-инфекций и значительная гетерогенность этой группы по концентрации NT-proBNP в крови. В исследовании не оценивались ранние маркеры повреждения миокарда (галектин-3, sST2, микро-рибонуклеиновая кислота-27), которые могли бы подтвердить наличие ХСН у боль- [5]. Более низкий показатель частоты встречаемости ХСН, возможно, был связан с тем, что 90% больных в исследовании получали антиретровирусную терапию, 62% из них -с хорошим эффектом.…”