Prognostic threshold levels of NT-proBNP testing in primary care

Rosenberg, Jens; Schou, Morten; Gustafsson, Finn; Badskjaer, J; Hildebrandt, Per

doi:10.1093/eurheartj/ehn525

Cited by 26 publications

(12 citation statements)

References 21 publications

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“…Rosenberg et al in a large group of 5875 cardiac patients showed significant relation of elevated NT-proBNP in a range 83 -118 pg/ml with a 90% increased risk for cardiovascular mortality within three years of follow-up. Elevations above 83 pg/ml were found in 7,7% of our survivors, none of our volunteers had elevated values of this marker [26].…”

Section: Discussionmentioning

confidence: 42%

Long-term cardiac effects of treatment for childhood leukemia

Urbanová

Urbán²,

Šimková³

et al. 2010

neo

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Late cardiac complications in cancer survivors may develop from subclinical myocardial damage. Biochemical correlates of minimal myocardial changes can be analyzed using a commercially available rapid assay. Biomarkers are considered more sensitive markers of subclinical cardiotoxicity than conventional electrocardiographic and echocardiographic methods.The aim of this study was to determine the values of plasma N-terminal pro brain natriuretic peptide (NT-pro-BNP) and cardiac troponin T (cTnT) in asymptomatic childhood leukemia survivors after anthracycline therapy in comparison with healthy volunteers. The survivors also underwent a detailed echocardiography.Twenty six survivors of leukemia previously treated with anthracyclines with total cumulative dose 95-600 (median 221) mg/m 2 were evaluated. Analyses of cTnT and NT-proBNP from blood samples and echocardiography were performed 5-25 years after completion of therapy for childhood leukemia. Control group for biochemical analyses consisted of 22 age-and gender-matched apparently healthy volunteers.Values of NT-proBNP were significantly elevated in ANT group compared to controls (35.1 ± 37.8 vs. 9.6 ± 6.7 pg/ml, P<0.010). CTnT remained below the diagnostic cut-off values in both groups. All echocardiographic parameters of patients remained normal.In conclusion, differences in NT-proBNP values between patients treated with anthracyclines and healthy volunteers might signal an initial stage of anthracycline-induced myocardial damage. The potential of this biomarker to detect subclinical anthracycline-induced myocardial alterations before development of echocardiographic and clinical changes is promising. Key words: cardiotoxicity, natriuretic peptides, cardiac troponins, anthracyclines, echocardiographyNeoplasma 57, 2, 2010 doi:10.4149/neo_2010_02_179Abbreviations: ANT group -patients previously treated with anthracyclines; cTn -cardiac troponins; cTnT -cardiac troponinT; NPs -natriuretic peptides; NT-proBNP -N-terminal fragment of the brain natriuretic peptide precursor; LV -left ventricular; LVEDD -left ventricular end-diastolic diameter; LVESD -left ventricular end-systolic diameter; LA -left atrium dimension; RV -right ventricular dimension; EF -ejection fraction; E -early diastolic flow velocity; A -late diastolic flow velocity; DT -deceleration time; IVRT -left ventricular isovolumetric relaxation time; TDI -tissue Doppler imaging; Ea -early diastolic velocity of the medial mitral annulus; Em; Sa -systolic velocity; Am -late diastolic velocity

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Section: Discussionmentioning

confidence: 42%

Long-term cardiac effects of treatment for childhood leukemia

Urbanová

Urbán²,

Šimková³

et al. 2010

neo

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“…[24][25][26][27][28][29][30] In spite of the fact that these tools are widely available and frequently introduced in clinical settings, the cardiac structural and functional remodeling studied by utilizing TDI and RT3D has rarely been conducted in patients with OSAS to evaluate their cardiac function. [31][32][33][34][35][36][37] In addition, the frequent coexistence of OSAS and congestive heart failure in clinical scenarios make it difficult to clearly define the exact impact of OSAS on cardiac remodeling and function, and vice versa.…”

Section: Brief Summarymentioning

confidence: 99%

Influence and Predicting Variables of Obstructive Sleep Apnea on Cardiac Function and Remodeling in Patients without Congestive Heart Failure

Chen

Liu

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objective: Obstructive sleep apnea syndrome (OSAS) has been considered to be an important predisposing factor for cardiovascular disease. This study aims to investigate the impact of OSAS on cardiac function and remodeling in patients without congestive heart failure. Methods: A total of 79 patients with sleep disordered breathing, preserved systolic function, and normal pro-brain natriuretic peptide level were enrolled. Sixty-fi ve patients were classifi ed to have moderate to severe OSAS (apnea-hypopnea index [AHI] ≥ 15/h), while the other 14 patients with mild or no OSAS (AHI < 15/h) served as control subjects. Baseline clinical and polysomnographic variables as well as tissue Doppler imaging and three-dimensional echocardiographic parameters were obtained. Results:The body mass index, neck circumference, Epworth Sleepiness Scale, desaturation index, arousal index, and snoring index were signifi cantly higher in patients with moderate to severe OSAS than those without (p < 0.05). The left atrial size, mitral A-wave velocity, and left ventricular end-diastolic volume were signifi cantly larger, while E/A ratio was lower in patients with moderate to severe OSAS than those without (p < 0.05). Notably, AHI in REM sleep was signifi cantly correlated with the aortic root size, E/A ratio, left ventricular volume, and stroke volume. In addition, the area under the receiver operator characteristic curve for AHI in REM sleep ≥ 32.3/h was 0.647 (95% CI [0.525, 0.769]) in predicting the development of left ventricular diastolic dysfunction. AHI in REM sleep ≥ 32.3/h was the only independent variant in predicting diastolic dysfunction after adjusting the variables including age, gender, hypertension, and body mass index. Conclusions: Patients with moderate to severe OSAS tend to have cardiac dysfunction revealed by echocardiography. High AHI in REM sleep is signifi cantly associated with cardiovascular remodeling and ventricular diastolic dysfunction, and may be a potential variable to predict cardiac dysfunction. Keywords: Echocardiography, sleep apnea syndrome, diastolic dysfunction, cardiovascular remodeling Citation: Chen YL; Su MC; Liu WH; Wang CC; Lin MC; Chen MC. Infl uence and predicting variables of obstructive sleep apnea on cardiac function and remodeling in patients without congestive heart failure.

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“…25) High levels of NT-proBNP in the blood are characterized by a large molecular weight, and NTproBNP has a long half-life compared to BNP. 25) Measurement of NTproBNP is possible in serum, as it has a more stable value than BNP. We found that the median value of NTproBNP was higher at PPD7 than at GW36 or PPM1.…”

Section: Discussionmentioning

confidence: 99%

Detection of Peripartum Myocardial Burden by Vector-Projected 187 Channel Electrocardiography and Serum NT-proBNP

et al. 2013

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SummaryThere is no reliable method of screening for pregnant women at high risk of developing severe myocardial disorders. In this study, we used vector-projected 187 channel electrocardiography (DREAM-ECG) and serum biochemical markers to evaluate peripartum myocardial burden in pregnant women. Forty-one pregnant women were examined at 36-37 weeks gestation (GW36), 7 days postpartum (PPD7), and 1 month postpartum (PPM1). Ten non-pregnant control women were assessed at a single time point. Heart rate, sympathetic index, and repolarization index (RTc dispersion) were quantified using the DREAM-ECG system, and serum levels of NT-proBNP, cardiac troponin T, estrogen, and progesterone were determined. Heart rate and the sympathetic index decreased from GW36 to PPM1 (P = 0.0031). The repolarization index decreased over time and was greater than in non-pregnant controls (31 ± 13 ms). Estrogen and progesterone at PPD7 and PPM1 were significantly lower than those at GW36 (P < 0.0001, P < 0.001). NT-proBNP at PPD7 was greater than at GW36 (median 29 pg/mL at GW36, 86 pg/mL at PPD7), and decreased at PPM1 in comparison to PPD7 (median 18.5 pg/mL). Troponin T was in the normal range during the whole period (< 0.003 ng/mL). In conclusion, these results indicate that the peripartum myocardial burden in pregnant women does not return to normal nonpregnant levels by PPM1. We propose that both repolarization indexes such as RTc dispersion by DREAM-ECG and serum biochemical markers may identify pregnant women at high risk of developing severe myocardial damage in the peripartum period. (Int Heart J 2013; 54: 140-145)

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Prognostic threshold levels of NT-proBNP testing in primary care

Abstract: We identified prognostic threshold levels for mortality and CV hospitalization for NT-proBNP in primary care patients suspected of HF. Our results have the potential to be used to risk-stratify waiting lists for echocardiography.

Cited by 26 publications

References 21 publications

Long-term cardiac effects of treatment for childhood leukemia

Long-term cardiac effects of treatment for childhood leukemia

Influence and Predicting Variables of Obstructive Sleep Apnea on Cardiac Function and Remodeling in Patients without Congestive Heart Failure

Detection of Peripartum Myocardial Burden by Vector-Projected 187 Channel Electrocardiography and Serum NT-proBNP

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