B‐type natriuretic peptide is associated with post‐discharge stroke in hospitalized patients with heart failure

Kono

Kaneshiro

et al. 2022

Preprint

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Although the prevalence of cognitive impairment and depression is higher in patients with atrial fibrillation (AF) than in the general population, the mechanism has not been fully examined and impact of catheter ablation (CA) of AF also remains unclear. Recently, the development of near-infrared spectroscopy (NIRS) has enabled noninvasive measurements of regional cerebral blood volume and brain activity, in terms of cerebral oxyhemoglobin in the cerebral cortex. We assessed brain activities by NIRS, depressive symptoms by the Center for Epidemiologic Studies Depression Scale (CES-D) and cognitive function by Mini-Mental State Examination (MMSE). We then compared the results between AF patients (paroxysmal AF n=18 and persistent AF n=14) and control subjects (n=29). Next, we also followed up persistent AF patients who kept sinus rhythm at 3 months after CA (n=8) and measured their brain activities using NIRS, CES-D and MMSE after CA to investigate the associations of changes in brain activities with changes in both CES-D and MMSE. Our results showed that 1) frontal and temporal brain activities were lower in patients with persistent AF than both in control subjects and paroxysmal AF patients (P<0.01), 2) frontal and temporal brain activities were improved in more than half of the persistent AF patients who kept sinus rhythm at 3 months after CA, especially in those who presented impaired brain activity before CA, and 3) improvement of frontal brain activity was associated with improvement of CES-D (R=-0.793, P=0.019), whereas improvement of temporal brain activity was associated with improvement of MMSE (R=0.749, P=0.033). NIRS measurement showed reduced frontal and temporal brain activities in the persistent AF patients, CA improved frontal and temporal brain activities in some of these patients, and associated with improvement of depressive state and/or improvement of cognitive function.

“…B-type natriuretic peptide levels were measured using a speci c immunoradiometric assay (Shionoria BNP kit, Shionogi, Osaka, Japan). 39…”

Section: Subjects and Study Protocolmentioning

confidence: 99%

Impaired Brain Activity in Patients With Persistent Atrial Fibrillation Assessed by Near-infrared Spectroscopy and Its Changes After Catheter Ablation

Kono

Kaneshiro

et al. 2022

Preprint

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“…Levels of CAVI were 10.4 (9.9, 11.1) in the high-CAVI group and 7.9 (6.8, 8.7) in the low-CAVI group (P 0.001). Comparisons of patient characteristics between the two groups are have recently reported that BNP is a predictor of stroke in patients with HF 25) . Impaired renal function is one of the important comorbidities of HF 2,13,14,34) .…”

Section: Resultsmentioning

confidence: 99%

“…The predictive value of CAVI was adjusted for three models: age and sex (Model 1); Model 1 plus atherosclerotic risk factors which differed between the groups, namely presence of coronary artery disease and diabetes mellitus (Model 2); and Model 1 plus severity of HF, namely New York Heart Association functional class or , B-type natriuretic peptide, and left ventricular ejection fraction (Model 3). After adjustment for the above confounding factors, high CAVI was an independent predictor of post-discharge stroke (Table 3 netic resonance imaging) or autopsy showed focal infarction or hemorrhage relevant to the symptoms [23][24][25] .…”

Section: Subjects and Protocolmentioning

confidence: 99%

Cardio-Ankle Vascular Index Predicts Post-Discharge Stroke in Patients with Heart Failure

Sato

Ichijo

et al. 2021

JAT

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We aimed to evaluate the significance of the cardio-ankle vascular index (CAVI) to predict stroke in patients with heart failure (HF).Methods: This was a prospective observational study, which recruited clinical data from a total of 557 patients who had been hospitalized for HF and undergone CAVI. According to the receiver operating characteristic curve analysis, the accurate cut-off value of CAVI in predicting post-discharge stroke was 9.64. We divided the patients into two groups: the high-CAVI group (HF patients with CAVI ≥ 9.64, n 111, 19.9%) and the low-CAVI group (HF patients with CAVI 9.64, n 446, 80.1%). We compared the patients' characteristics and post-discharge prognosis. The primary endpoint was stroke. Results:The high-CAVI group was older (73.0 vs. 65.5 years old, P 0.001). Male sex (73.9% vs. 61.4%, P 0.015), coronary artery disease (47.7% vs. 36.1%, P 0.024), and diabetes mellitus (54.1% vs. 37.4%, P 0.001) were more prevalent in the high-CAVI group. In contrast, there was no difference in left ventricular ejection fraction, and prevalence of hypertension and dyslipidemia. The Kaplan-Meier analysis demonstrated that post-discharge stroke rate was higher in the high-CAVI group than in the low-CAVI group (log-rank P 0.005). In multivariate Cox proportional hazard analysis, high CAVI was found to be an independent predictor of stroke, with an adjusted hazard ratio of 3.599, compared to low CAVI. Conclusion: CAVI independently predicts stroke in patients with HF.The trial registration number: UMIN000029132 pendently of BP, non-invasively represents the stiffness of the aorta, femoral artery, and tibial artery 6) . The formula of the index is as follows: CAVI a [(2 / P) ln (systolic BP / diastolic BP) PWV 2 ] b, where is blood density, P is pulse pressure, and a and b are coefficients 6) . CAVI also estimates atherosclerosis in the coronary and carotid arteries more closely than PWV 7,8) . CAVI is useful not only for the evaluation of arterial stiffness, but also for prognosis prediction in patients who are at high risk of CVDs [9][10][11][12] . However,

“…16 Evidence of thrombotic risk in patients with HF has been accumulated but is not yet sufficient. 16,60,61 Clinicians should modulate antithrombotic therapy on the basis of balancing both thrombotic and hemorrhagic risk (i.e., simplified ARC-HBR definition) in each patient with HF. More evidence is (Saitama Medical Center, Jichi Medical University, Saitama, Japan), a graphical user interface for R (R Foundation for Statistical Computing, Vienna, Austria).…”

Section: Discussionmentioning

confidence: 99%

Simplified Academic Research Consortium for High Bleeding Risk (ARC-HBR) Definition Predicts Bleeding Events in Patients With Heart Failure

Sato

Takeishi

et al. 2021

Circ J

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Background: It has recently been reported that the simplified Academic Research Consortium for High Bleeding Risk (ARC-HBR) definition, which excludes 6 rare criteria, is comparable to the original ARC-HBR definition in predicting major bleeding in patients with coronary artery disease (CAD) who undergo percutaneous coronary intervention. In this study, we investigated whether the simplified ARC-HBR definition could be applied to patients with heart failure (HF) to identify those at high bleeding risk (HBR). Methods and Results:In all, 2,437 patients hospitalized for HF were enrolled in this study. Patients were divided into 2 groups based on the simplified ARC-HBR definition: those at HBR (n=2,026; 83.1%) and those not (non-HBR group; n=411; 16.9%). The HBR group was older (72.0 vs. 61.0 years; P<0.001) and had a lower prevalence of CAD (31.1% vs. 36.5%; P=0.034) than the non-HBR group. Kaplan-Meier analysis showed that post-discharge bleeding events defined as hemorrhagic stroke or gastrointestinal bleeding were more frequent in the HBR than non-HBR group (log-rank P<0.001). The simplified ARC-HBR definition accurately predicted bleeding events (Fine-Gray model; hazard ratio 2.777, 95% confidence interval 1.464-5.270, P=0.001). Conclusions:The simplified ARC-HBR definition predicts a high risk of bleeding events in patients with HF.