Brain natriuretic peptide predicts survival in Chagas' disease more effectively than atrial natriuretic peptide

Heringer-Walther, Silvia; Moreira, M.C.V.; Wessel, Niels; Saliba, Joey; Silvia-Barra, J.; Pena, J.L.B.; Becker, S; Siems, Wolf‐Eberhard; Schultheiss, H.‐P.; Walther, Thomas

doi:10.1136/hrt.2003.026856

Cited by 21 publications

(22 citation statements)

References 5 publications

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“…Furthermore, individuals with Chagas cardiomyopathy, even in the absence of systolic dysfunction, had higher BNP levels than healthy controls (26). For those with heart failure due to Chagas cardiomyopathy, BNP has previously been shown to be a strong predictor of mortality (27) (26) (28) (31). NT-pro BNP levels are correlated with severity of LV dysfunction in Chagas disease (32).…”

Section: Discussionmentioning

confidence: 99%

“…The association of TIMP-1 with mortality is controversial (21, 24) (25) (22). To date, only BNP had been shown to predict mortality in Chagas cardiomyopathy (26), (27), (28). The objective of the current analysis was to evaluate the additive predictive value of serum biomarkers within the Chagas disease patient group already known to be at high risk of short-term mortality based on clinical and echocardiographic signs of heart failure.…”

Section: Introductionmentioning

confidence: 99%

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Biomarkers and Mortality in Severe Chagas Cardiomyopathy

Sherbuk

Okamoto

Marks

et al. 2015

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Background Chagas cardiomyopathy is a chronic sequela of infection by the parasite, Trypanosoma cruzi. Advanced cardiomyopathy is associated with a high mortality rate, and clinical characteristics have been used to predict mortality risk. Though multiple biomarkers have been associated with Chagas cardiomyopathy, it is unknown how these are related to survival. Objectives Our study aimed to identify biomarkers associated with mortality in individuals with severe Chagas cardiomyopathy in an urban Bolivian hospital. Methods The population included individuals with and without T. cruzi infection recruited in an urban hospital in Santa Cruz, Bolivia. Baseline characteristics, ECG findings, medications, and serum cardiac biomarker levels (BNP, NTproBNP, CKMB, troponin I, MMP-2, MMP-9, TIMP-1, TIMP-2, TGFb1, and TGFb2) were ascertained. Echocardiograms were preferentially performed on those with cardiac symptoms or electrocardiogram abnormalities. Participants were contacted by phone approximately 1 year after initial evaluation; deaths were reported by family members. Receiver operating characteristic curves were used to optimize cut-off values for each marker. For markers with area under curve > 0.55, Cox proportional hazards models were performed to determine the hazards ratio (HR) and 95% confidence interval (CI) for the association of each marker with mortality. Results The median follow-up time was 14.1 months (interquartile range 12.5- 16.7 months). Of 254 individuals with complete cardiac data, 220 (87%) had follow-up data. Of 50 patients with severe Chagas cardiomyopathy, 20 (40%) had died. Higher baseline levels of BNP (HR[95% CI]:3.1 [1.2, 8.4]), NTproBNP (4.4[1.8,11.0]), CKMB (3.3[1.3, 8.0]), and MMP-2 (4.2[1.5, 11.8]) were significantly associated with subsequent mortality. Conclusions Severe Chagas cardiomyopathy is associated with high short-term mortality. BNP, NTproBNP, CKMB and MMP2 have added predictive value for mortality, even in the presence of decreased ejection fraction and other clinical signs of congestive heart failure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biomarkers and Mortality in Severe Chagas Cardiomyopathy

Sherbuk

Okamoto

Marks

et al. 2015

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“…Surprisingly, although CD affects almost 18 million people in Latin America, apart from our group only three publications [17, 18] reported ANP [19] or BNP [20, 21] regulation in human CD patients.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Natriuretic Peptides in Chagas’ Disease: A 3-Year Follow-Up Investigation

Moreira

Heringer-Walther²,

Wessel³

et al. 2007

Cardiology

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Background: Chagas’ disease (CD) affects around 18 million people in Latin America. To determine the diagnostic and prognostic value of natriuretic peptides in patients with CD, we measured atrial (ANP) and brain natriuretic peptide (BNP), and compared the findings with other dilated cardiomyopathies (DCM). Methods: Blood samples were obtained from 111 CD patients, 62 patients with DCM due to other causes, and 43 gender- and age-matched healthy subjects. The CD and DCM patients were subdivided according to their NYHA classification. Natriuretic peptide concentrations were determined by immunoradiometric assays. Results: ANP and more pronounced BNP levels were increased in CD and DCM patients in relation to the NYHA class. Circulating BNP concentrations were higher in CD patients in NYHA classes I–II than in the corresponding DCM patients (p = 0.020). Importantly, ANP and BNP were already significantly elevated in CD patients without systolic ventricular dysfunction (p ≤ 0.001). In CD patients, both peptides were highly correlated with echocardiographic parameters (p < 10^–14). Both ANP and BNP had comparable ability to predict death or the necessity for heart transplant (p < 0.0001). Conclusion: Natriuretic peptide levels can be used as a marker of asymptomatic CD without ventricular dysfunction and thus could be an ideal tool to identify these patients for early therapy.

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“…Therefore, it is not surprising that these markers have already been tested in patients with Chagas' heart disease, where it was found that levels of BNP increase with disease severity [148][149][150][151][152][153][154][155]. In patients with chronic Chagas' disease, characterized by LVEF \ 40%, levels of BNP were significantly higher than those in patients with LVEF [ 40%.…”

Section: Early Diagnosis and Monitoring Of Chagas' Heart Diseasementioning

confidence: 93%

“…It was recently found in a group of patients with chagasic cardiomyopathy that the BNP level correlated with diastolic function patterns, regardless of the systolic function [159]. Using end points such as death and heart transplantation, BNP predicts the outcome of Chagas' patients [154,155]. Higher values for the marker NTpro-BNP were also demonstrated in chagasic patients with heart disease [160][161][162].…”

Section: Early Diagnosis and Monitoring Of Chagas' Heart Diseasementioning

confidence: 97%

Chronic Chagas’ heart disease: a disease on its way to becoming a worldwide health problem: epidemiology, etiopathology, treatment, pathogenesis and laboratory medicine

et al. 2010

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Chagas' disease, caused by Trypanosoma cruzi infection, is ranked as the most serious parasitic disease in Latin America. Nearly 30% of infected patients develop life-threatening complications, and with a latency of 10-30 years, mostly Chagas' heart disease which is currently the major cause of morbidity and mortality in Latin America, enormously burdening economic resources and dramatically affecting patients' social and labor situations. Because of increasing migration, international tourism and parasite transfer by blood contact, intrauterine transfer and organ transplantation, Chagas' heart disease could potentially become a worldwide problem. To raise awareness of this problem, we reflect on the epidemiology and etiopathology of Chagas' disease, particularly Chagas' heart disease. To counteract Chagas' heart disease, in addition to the general interruption of the infection cycle and chemotherapeutic elimination of the infection agent, early and effective causal or symptomatic therapies would be indispensable. Prerequisites for this are improved knowledge of the pathogenesis and optimized patient management. From economic and logistics viewpoints, this last prerequisite should be performed using laboratory medicine tools. Consequently, we first summarize the mechanisms that have been suggested as driving Chagas' heart disease, mainly those associated with the presence of autoantibodies against G-protein-coupled receptors; secondly, we indicate new treatment strategies involving autoantibody apheresis and in vivo autoantibody neutralization; thirdly, we present laboratory medicine tools such as autoantibody estimation and heart marker measurement, proposed for diagnosis, risk assessment and patient guidance and lastly, we critically reflect upon the increase in inflammation and oxidative stress markers in Chagas' heart disease.

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Brain natriuretic peptide predicts survival in Chagas' disease more effectively than atrial natriuretic peptide

Cited by 21 publications

References 5 publications

Biomarkers and Mortality in Severe Chagas Cardiomyopathy

Biomarkers and Mortality in Severe Chagas Cardiomyopathy

Prognostic Value of Natriuretic Peptides in Chagas’ Disease: A 3-Year Follow-Up Investigation

Chronic Chagas’ heart disease: a disease on its way to becoming a worldwide health problem: epidemiology, etiopathology, treatment, pathogenesis and laboratory medicine

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