The minimal informative monitoring interval of N-terminal pro-B-type natriuretic peptide in patients with stable heart failure

Dai, Zhehao; Asano, Taku; Takahashi, Osamu; Komiyama, Nobuyuki; Ohde, Sachiko

doi:10.1186/s12872-020-01537-7

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…Another concern in this study and in other studies on serial NT-proBNP measurement is the intra-individual variability and measurement error, which can account for up to 40% of its change in patients without HF and up to 60% in patients with stable HF per previous reports . This complicates the distinction of the true change from the noise and may be one reason why the continuous models demonstrated nonsignificant results after adjustment .…”

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confidence: 78%

Serial N-Terminal Pro–B-Type Natriuretic Peptide Measurements in the Population Without Clinical Heart Failure

Dai

Ohde

2023

JAMA Cardiol

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To the Editor Jia et al 1 investigated the associations between 6-year change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the risk of heart failure (HF) hospitalization and all-cause death among adults without prior HF, using the data from the Atherosclerosis Risk in Communities (ARIC) study. The investigators provide a successful example of using large-scale observational data with long-term followup. Along with a previous study on elderly patients without HF, 2 the current study extends our knowledge of serial NT-proBNP measurements in the patients on the spectrum from clinical HF to pre-HF. This promising approach may aid in stratifying patients for precise primary HF prevention.Although we agree that serial NT-proBNP provides additional information beyond the baseline measurement, in our opinion, the authors' emphasis on the role that the change of NT-proBNP plays in prognosis prediction is not substantiated by their data and may be misleading. First, based on Table 2 and eFigure 2 in Supplement 1, 1 patients in the high/high category were of the highest probability of events, followed by those in low/high, high/low, and low/low categories. 1 However, patients in the low/high category, but not the high/high category, are expected to have the greatest increase in NT-proBNP levels. This contradicts their conclusion on the association between the change of NT-proBNP and events. Second, the associations between the change in NT-proBNP and HF hospitalization and all-cause mortality were substantially attenuated, with most of them neutralized, after adjusting for the latest NT-proBNP level, as shown in Table 3, 1 leaving only the categorized model predicting all-cause death barely significant. The above 2 points argue against the conclusion that change of NT-proBNP matters and instead support the hypothesis that the latest measurement is of more predictive value, as raised in a recent study by Wolsk et al. 3 Another concern in this study and in other studies on serial NT-proBNP measurement is the intra-individual variability and measurement error, which can account for up to 40% of its change in patients without HF and up to 60% in patients with stable HF per previous reports. 4,5 This complicates the distinction of the true change from the noise and may be one reason why the continuous models demonstrated nonsignificant results after adjustment. 1 In the current study, the investigators set the cutoff as a 25% change of NT-proBNP in the categorized model. Additional information on how this cutoff was established would further help readers translate the current results into their clinical practice.

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confidence: 78%

Serial N-Terminal Pro–B-Type Natriuretic Peptide Measurements in the Population Without Clinical Heart Failure

Dai

Ohde

2023

JAMA Cardiol

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“…Moreover, the magnitude of difference between the POC and laboratory devices is similar to those seen between the various laboratory assays for BNP and NT-proBNP produced by different manufacturers, 18 , 19 as immunoassays vary with respect to antibody specificity 20 and the population characteristics of those assessed. 21 Perhaps more important are the few recorded cases where there has been significant variation from visit to visit, and lack of concordance between POC and laboratory readings ( Figures 2 3 ), suggesting operator error rather than measurement bias. If POC testing is to be incorporated into routine primary care, it is imperative that operators are trained in its usage, and checks are developed to prevent and identify irregular results.…”

Section: Discussionmentioning

confidence: 98%

Point-of-care NT-proBNP monitoring for heart failure: observational feasibility study in primary care

et al. 2022

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BackgroundAround one million individuals in the UK have heart failure (HF), a chronic disease that causes significant morbidity and mortality. N-terminal pro–B-type natriuretic peptide (NT-proBNP) monitoring could help improve the care of patients with HF in the community.AimThe aim of this study is to provide evidence to support the routine use of point-of-care (POC) NT-proBNP monitoring in primary care.Design & settingIn this observational cohort study, the Roche Cobas h 232 POC device was used to measure NT-proBNP in 27 patients with HF at 0, 6 and 12 months, with a subset reanalysed in the laboratory for comparison.MethodData were analysed for within- and between-person variability and concordance with laboratory readings using Passing–Bablok regression. GPs reported whether POC results impacted clinical decision-making, and patients indicated their willingness to participate in long-term cohort studies using the Likert acceptability scale.ResultsWithin-person variability in POC NT-proBNP over 12 months was 881 pg/mL (95% C.I. 380–1382 pg/mL). Between-person variability was 1972 pg/mL (95% C.I. 1,525–2791 pg/mL). Passing–Bablok regression showed no significant systematic difference between POC and laboratory measurements. Patients indicated a high level of acceptability, and GP decision-making was affected for at least one visit in a third of patients.ConclusionWithin person variability in POC NT-proBNP is around half of between-person variability, so detecting changes could be of use in HF management. High patient acceptability and impact on clinical decision-making warrant further investigation in a larger long-term cohort study.

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“…In cardiomyocytes with disorganized sarcomeres, all the texture quality parameters dramatically drop. The loss of a correct sarcomere structure is a typical feature of some heart failure pathologies (cardiac hypertrophy and cardiomyopathies) 36 – 38 . Moreover, sarcomere disruption is frequently correlated to changes of the expression of both contractile and regulatory proteins 38 , 39 .…”

Section: Discussionmentioning

confidence: 99%

“…The loss of a correct sarcomere structure is a typical feature of some heart failure pathologies (cardiac hypertrophy and cardiomyopathies) 36 – 38 . Moreover, sarcomere disruption is frequently correlated to changes of the expression of both contractile and regulatory proteins 38 , 39 . We observed that the expression of sarcomeric α-actin and Tropomyosin proteins is altered and we propose that the skewed protein ratio of two (in our experimental conditions) proteins of those making up the sarcomeres may contribute to disrupt their organization, as also reported previously 14 , 31 , 40 .…”

Section: Discussionmentioning

confidence: 99%

Functional and structural phenotyping of cardiomyocytes in the 3D organization of embryoid bodies exposed to arsenic trioxide

Rebuzzini

Civello

Fassina

et al. 2021

Sci Rep

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Chronic exposure to environmental pollutants threatens human health. Arsenic, a world-wide diffused toxicant, is associated to cardiac pathology in the adult and to congenital heart defects in the foetus. Poorly known are its effects on perinatal cardiomyocytes. Here, bioinformatic image-analysis tools were coupled with cellular and molecular analyses to obtain functional and structural quantitative metrics of the impairment induced by 0.1, 0.5 or 1.0 µM arsenic trioxide exposure on the perinatal-like cardiomyocyte component of mouse embryoid bodies, within their 3D complex cell organization. With this approach, we quantified alterations to the (a) beating activity; (b) sarcomere organization (texture, edge, repetitiveness, height and width of the Z bands); (c) cardiomyocyte size and shape; (d) volume occupied by cardiomyocytes within the EBs. Sarcomere organization and cell morphology impairment are paralleled by differential expression of sarcomeric α-actin and Tropomyosin proteins and of acta2, myh6 and myh7 genes. Also, significant increase of Cx40, Cx43 and Cx45 connexin genes and of Cx43 protein expression profiles is paralleled by large Cx43 immunofluorescence signals. These results provide new insights into the role of arsenic in impairing cytoskeletal components of perinatal-like cardiomyocytes which, in turn, affect cell size, shape and beating capacity.

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The minimal informative monitoring interval of N-terminal pro-B-type natriuretic peptide in patients with stable heart failure

Cited by 6 publications

References 31 publications

Serial N-Terminal Pro–B-Type Natriuretic Peptide Measurements in the Population Without Clinical Heart Failure

Serial N-Terminal Pro–B-Type Natriuretic Peptide Measurements in the Population Without Clinical Heart Failure

Point-of-care NT-proBNP monitoring for heart failure: observational feasibility study in primary care

Functional and structural phenotyping of cardiomyocytes in the 3D organization of embryoid bodies exposed to arsenic trioxide

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