NT-proBNP as a Cornerstone for Prognosis in Valve Disease

Bergler‐Klein, Jutta

doi:10.1016/j.jacc.2020.02.030

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…It has been shown that the NT-proBNP is secreted primarily from cardiomyocytes in response to ischemia or increased wall stress. Elevated levels of serum NT-proBNP are widely used as significant indicators to predict clinical diagnosis, mortality, and hospitalization in patients with cardiac dysfunction, coronary hypoperfusion, and cardiovascular disease ( 25 , 26 ). Candemir et al.…”

Section: Discussionmentioning

confidence: 99%

Establishment and verification of a nomogram that predicts the risk for coronary slow flow

Yu,

Ran,

et al. 2024

Front. Endocrinol.

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BackgroundCoronary slow flow (CSF) has gained significance as a chronic coronary artery disease, but few studies have integrated both biological and anatomical factors for CSF assessment. This study aimed to develop and validate a simple-to-use nomogram for predicting CSF risk by combining biological and anatomical factors.MethodsIn this retrospective case-control study, 1042 patients (614 CSF cases and 428 controls) were randomly assigned to the development and validation cohorts at a 7:3 ratio. Potential predictive factors were identified using least absolute shrinkage and selection operator regression and subsequently utilized in multivariate logistic regression to construct the nomogram. Validation of the nomogram was assessed by discrimination and calibration.ResultsN-terminal pro brain natriuretic peptide, high density lipoprotein cholesterol, hemoglobin, left anterior descending artery diameter, left circumflex artery diameter, and right coronary artery diameter were independent predictors of CSF. The model displayed high discrimination in the development and validation cohorts (C-index 0.771, 95% CI: 0.737-0.805 and 0.805, 95% CI: 0.757-0.853, respectively). The calibration curves for both cohorts showed close alignment between predicted and actual risk estimates, demonstrating improved model calibration. Decision curve analysis suggested high clinical utility for the predictive nomogram.ConclusionThe constructed nomogram accurately and individually predicts the risk of CSF for patients with suspected CSF and may be considered for use in clinical care.

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Section: Discussionmentioning

confidence: 99%

Establishment and verification of a nomogram that predicts the risk for coronary slow flow

Yu,

Ran,

et al. 2024

Front. Endocrinol.

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“…Choosing the optimal time for intervention, whether surgical or percutaneous, requires constant monitoring of patients [24]. The presence of symptoms and/or signs of left ventricular dysfunction in imaging studies are key guidelines for qualifying patients for invasive treatment of valvular heart disease.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the N-Terminal of the Prohormone Brain Natriuretic Peptide in Predicting Acute Kidney Injury Requiring Renal Replacement Therapy in Patients Undergoing Heart Valve Surgery

Duchnowski,

Śmigielski

2023

Medicina

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Background and Objectives: By definition, acute kidney injury (AKI) is a clinical syndrome diagnosed when the increase in serum creatinine concentration is >0.3 mg/dL in 48 h or >1.5-fold in the last seven days or when diuresis < 0.5 mL/kg/h for a consecutive 6 h. AKI is one of the severe complications that may occur in the early postoperative period in patients undergoing heart valve surgery, significantly increasing the risk of death. Early implementation of renal replacement therapy increases the chances of improving treatment results in patients with postoperative AKI. The study assessed the predictive ability of selected preoperative and perioperative parameters for the occurrence of postoperative AKI requiring renal replacement therapy in the early postoperative period in a group of patients with severe valvular heart disease. Materials and Methods: A prospective study was conducted on a group of patients undergoing consecutive heart valve surgeries. The primary endpoint was postoperative AKI requiring renal replacement therapy. AKI was diagnosed with an increase in serum creatinine > 0.3 mg/dL in 48 h or >1.5-fold in the previous 7 days and/or a decrease in diuresis < 0.5 mL/kg/h for 6 h. The observation period was until the patient was discharged home or death occurred. Logistic regression analysis was used to assess which variables were predictive of primary endpoint, and odds ratios (OR) were calculated with a 95% confidence interval (CI). Multivariate analysis was based on the result of single factor logistic regression, i.e., to further steps, all statistically significant variables were taken into consideration. Results: A total of 607 patients were included in the study. The primary endpoint occurred in 50 patients. At multivariate analysis: NT-proBNP (OR 1.406; 95% CI 1.015–1.949; p = 0.04), CRP (OR 1.523; 95% CI 1.171–1.980; p = 0.001), EuroSCORE II (OR 1.090; 95% CI 1.014–1.172; p = 0.01), age (OR 1.037; 95% CI 1.001–1.075; p = 0.04) and if they stayed in the intensive care unit longer than 2 days (OR 9.077; 95% CI 2.026–40.663; p = 0.004) remained the independent predictors of the primary endpoint. The mean preoperative NT-proBNP level was 2063 pg/mL (±1751). Thirty-eight patients with AKI requiring renal replacement therapy died in intrahospital follow-up. Conclusions: The results of the presented study indicate that a high preoperative level of NT-proBNP and postoperative hemodynamic instability may be associated with a significant risk of a postoperative AKI requiring renal replacement therapy. The results of the study may also suggest that qualifying for heart valve surgery earlier may be associated with improved prognosis in this group of patients.

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“…In patients with SMR, compensatory mechanisms that change the contractile ability to maintain hemodynamics in the face of increased afterload or preload may stop working over time, which may precede or accompany clinical deterioration of the patient's condition. The heart may undergo hypertrophic remodeling in response to a variety of stimuli ( 15 ). Depending on the stimulus, this hypertrophic growth may be partially or completely reversible.…”

Section: Discussionmentioning

confidence: 99%

Angiotensin receptor-neprilysin inhibitors and cardiac remodeling

Ryazanov

Ших

Makarovskaya³

et al. 2023

Braz J Med Biol Res

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The aim of this study was to determine how sacubitril/valsartan compared with valsartan in an outpatient setting affects left ventricular remodeling in heart failure with reduced ejection fraction and functional (or secondary) mitral regurgitation (SMR) due to the effect of dual inhibition of the renin-angiotensin system and neprilysin. The outpatient study included 90 patients with chronic SMR who were followed up for 12 months. They received sacubitril/valsartan or valsartan instead of the more commonly used angiotensin-converting enzyme inhibitor enalapril for heart failure, in addition to standard medical therapy for heart failure. The difference in NT-proBNP change between groups was the primary endpoint. Changes in effective regurgitation orifice area, left ventricular ejection fraction, left ventricular end-systolic and end-diastolic volume indices, left atrial volume index, E/e' index, and exercise tolerance on the 6-minute walk test were secondary endpoints. In the treatment efficacy analysis, NT-proBNP levels decreased significantly by 37% in the sacubitril/valsartan group and by 11% in the valsartan group (P<0.001). Ejection fraction and exercise tolerance (increase in walking distance in the 6-min test) increased in the sacubitril/valsartan group (P<0.05). Also, in this group, the effective area of the regurgitation orifice, the left atrial volume index, the E/e' index, and the indices of the end-systolic and end-diastolic volume of the left ventricle (P<0.05) decreased more pronouncedly. Compared with valsartan, treatment with sacubitril/valsartan led to a significant improvement in cardiac remodeling in patients with SMR and heart failure with reduced ejection fraction.

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NT-proBNP as a Cornerstone for Prognosis in Valve Disease

Cited by 5 publications

References 16 publications

Establishment and verification of a nomogram that predicts the risk for coronary slow flow

Establishment and verification of a nomogram that predicts the risk for coronary slow flow

Usefulness of the N-Terminal of the Prohormone Brain Natriuretic Peptide in Predicting Acute Kidney Injury Requiring Renal Replacement Therapy in Patients Undergoing Heart Valve Surgery

Angiotensin receptor-neprilysin inhibitors and cardiac remodeling

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