NT-proBNP for Risk Prediction in Heart Failure

Vergaro, Giuseppe; Gentile, Francesco; Meems, Laura M.G.; Aimo, Alberto; Januzzi, James L.; Richards, A. Mark; Lam, Carolyn S.P.; Latini, Roberto; Staszewsky, Lidia; Anand, Inder; Cohn, Jay N.; Ueland, Thor; Gullestad, Lars; Aukrust, Pål; Rocca, Hans‐Peter Brunner‐La; Bayés‐Genís, Antoni; Lupón, Josep; Yoshihisa, Akiomi; Takeishi, Yasuchika; Egstrup, Michael; Gustafsson, Ida; Gaggin, Hanna K.; Eggers, Kai M.; Huber, Kurt; Gamble, Greg; Ling, Lieng H.; Leong, Kui Tong Gerard; Yeo, Poh Shuah Daniel; Ong, Hean Yee; Jaufeerally, Fazlur; Ng, Tze Pin; Troughton, Richard W.; Doughty, Robert N.; Devlin, Gerry; Lund, Mayanna; Giannoni, Alberto; Passino, Claudio; Boer, Rudolf A. de; Emdin, Michele

doi:10.1016/j.jchf.2021.05.014

Cited by 30 publications

(25 citation statements)

References 47 publications

(45 reference statements)

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“…NT-proBNP levels are inversely correlated with body mass index, and clinicians should take this into consideration when observing values in pregnancy. 34 Our findings were similar when taking into account body mass index, and although our cohort was mostly normal/mildly overweight before pregnancy (80%), 20% were obese suggesting that the changes in NT-proBNP observed through pregnancy and between subgroups are likely widely applicable. The majority of women (98%) in this cohort have normal renal function; therefore, our findings should not be extrapolated to women with renal dysfunction.…”

Section: Discussionsupporting

confidence: 76%

Trending Cardiac Biomarkers During Pregnancy in Women With Cardiovascular Disease

Chang

Khakh

Janzen

et al. 2022

Circ: Heart Failure

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Background: Clinical utility of cardiac biomarker testing during pregnancy in women with preexisting cardiac disease is not well known. We studied the levels and temporal trends of NT-proBNP (N-terminal pro-B-type natriuretic peptide) and hs-cTnI (high-sensitivity cardiac troponin I) throughout pregnancy in women with preexisting cardiac disease and sought to assess the association between NT-proBNP and hs-cTnI and pregnancy outcomes. Methods: Three hundred seven pregnant women with preexisting cardiac disease were prospectively recruited. Mixed-effects linear regression analysis was used to compare the NT-proBNP and hs-cTnI levels between time periods and subgroups. Logistic regression analysis adjusted for maternal age and CARPREG II (Cardiac Disease in Pregnancy) risk score assessed the association between NT-proBNP levels and adverse events. Results: Geometric mean NT-proBNP (95% CI) was stable through pregnancy with a transient significant increase with labor and delivery (101.4 pg/mL [87.1–118.1], 90.2 pg/mL [78.5–103.6], 153.6 pg/mL [126.8–186.1], and 112.2 pg/mL [94.2–133.7] for first/second trimester, third trimester, labor/delivery and postpartum, respectively). We observed a statistically significant difference in the NT-proBNP between women with preserved versus decreased systemic ventricular function, structurally normal versus abnormal heart, modified World Health Organization class 1, 2 versus modified World Health Organization class 3, 4 and no congenital heart disease versus congenital heart disease. Compared to those without events, median (interquartile range) NT-proBNP levels were significantly higher in those who had heart failure (204 pg/mL [51–450] versus 55 pg/mL [31–97]; P =0.001) and preeclampsia (98 pg/mL [40–319] versus 55 pg/mL [31–99]; P =0.027). NT-proBNP, adjusted for age and CARPREG II risk score, was significantly associated with combined heart failure and preeclampsia (adjusted odds ratio, 2.14 [95% CI, 1.48–3.10] per log NT-proBNP increase; P <0.001). NT-proBNP <200 pg/mL had a specificity of 91% and negative predictive value of 95% in predicting combined heart failure and preeclampsia. Conclusions: NT-proBNP remains steady over the course of pregnancy with a transient increase during labor and delivery with higher levels in subgroups of stable cardiac patients. NT-proBNP level of 200 pg/mL can be used in the diagnosis of heart failure/preeclampsia in the pregnant cardiac population.

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Section: Discussionsupporting

confidence: 76%

Trending Cardiac Biomarkers During Pregnancy in Women With Cardiovascular Disease

Chang

Khakh

Janzen

et al. 2022

Circ: Heart Failure

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“…Then, Cox proportional hazards regression analysis was used to determine the multivariable-adjusted association of SHS exposure time with incident HF (any, HFrEF, HFpEF, and HF of ischaemic and non-ischaemic origins) in the self-report cohort and in the cohort subset. Covariates used in the model were chosen based on previously published associations with active smoking and HF, [30][31][32][33][34][35][36] which included age, sex, race/ethnicity, education level, income status, health insurance status, BMI, tobacco pack-years, alcohol intake status, diabetes status, hypertension status, CKD status, total cholesterol, statin use, physical activity, hs-CRP (log e transformed), NT-proBNP (log e transformed), the use of antipsychotics or tricyclic antidepressants, and urinary creatinine (for the cohort subset only). Since hypertension accounted for more than half of the HF events in the MESA study, 37 and urinary cotinine excretion may be lower in CKD, 38 both hypertension and CKD were crucial confounders of the association.…”

Section: Discussionmentioning

confidence: 99%

Association between secondhand smoke exposure and incident heart failure: The Multi‐Ethnic Study of Atherosclerosis (MESA)

Lin,

Lloyd‐Jones,

Colangelo

et al. 2024

European J of Heart Fail

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AimsThere are no studies on the association between secondhand smoke (SHS) exposure and incident heart failure (HF). This cohort study aimed to examine the associations of self‐reported and urinary cotinine‐assessed SHS exposure with incident HF.Methods and resultsThis study included 5548 non‐active smoking participants aged 45–84 years and free of known cardiovascular diseases and HF at baseline who self‐reported SHS exposure time in the Multi‐Ethnic Study of Atherosclerosis (MESA) at baseline (2000–2002). A cohort subset of 3376 non‐active smoking participants underwent urinary cotinine measurements. HF events were verified by medical records or death certificates and ascertained from baseline through 2019. Multivariable Cox proportional hazards regression analysis was used with adjustment for demographic variables, traditional cardiovascular risk factors, physical activity, tobacco pack‐years and medications. During a median follow‐up of 17.7 years, 353 and 196 HF events were identified in the self‐report cohort and cohort subset, respectively. In the self‐report cohort, compared with the SHS unexposed group (0 h/week), the highest tertile of the SHS exposed group (7–168 h/week) was not associated with incident HF (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.49–1.00; p = 0.052). In contrast, in the cohort subset, participants with detectable urinary cotinine >7.07 ng/ml had a higher risk of incident HF than those with undetectable urinary cotinine ≤7.07 ng/ml (HR 1.45, 95% CI 1.03–2.06; p = 0.034). There were no significant heterogeneities in HF risk by age, sex, race/ethnicity, or past smoking status.ConclusionSecondhand smoke exposure reflected by modestly increased urinary cotinine (>7.07 ng/ml) rather than self‐report in non‐active smokers was associated with a 40–50% higher risk of any HF event.

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“…Future investigations focused on HFpEF risk among individuals with obesity to elucidate the role of BMI-specific cutoffs for natriuretic peptide assessment, as well as the identification of other specific biomarkers or noninvasive surrogates of early hemodynamic HFpEF will be important. 13 Additionally, the role of evolving medical therapies in individuals with hemodynamic HFpEF without overt rest congestion remains to be studied.…”

Section: Discussionmentioning

confidence: 99%

“…12 Additionally, NT-proBNP (N-terminal pro-B-type natriuretic peptide) values are consistently lower in the setting of obesity, limiting biochemical corroboration of HFpEF diagnosis. 10,13 Finally, echocardiographic assessment may be more challenging in the setting of obesity due to limited acoustic windows, as well as underestimation of circulatory congestion using traditional measures of diastolic function. 14 In this study, we sought to investigate the prevalence of clinically unrecognized HFpEF among a sample of adults with obesity and exertional dyspnea without known clinical HFpEF or underlying cardiovascular disease (CVD).…”

mentioning

confidence: 99%

Uncovering Unrecognized Heart Failure With Preserved Ejection Fraction Among Individuals With Obesity and Dyspnea

Kosyakovsky,

Liu,

Wang

et al. 2024

Circ: Heart Failure

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BACKGROUND: Although heart failure with preserved ejection fraction (HFpEF) has become the predominant heart failure subtype, it remains clinically under-recognized. HFpEF diagnosis is particularly challenging in the setting of obesity given the limitations of natriuretic peptides and resting echocardiography. We examined invasive and noninvasive HFpEF diagnostic criteria among individuals with obesity and dyspnea without known cardiovascular disease to determine the prevalence of hemodynamic HFpEF in the community. METHODS: Research volunteers with dyspnea and obesity underwent resting echocardiography; participants with possible pulmonary hypertension qualified for invasive cardiopulmonary exercise testing. HFpEF was defined using rest or exercise pulmonary capillary wedge pressure criteria (≥15 mm Hg or Δpulmonary capillary wedge pressure/Δcardiac output slope, >2.0 mm Hg·L −1 ·min − 1). RESULTS: Among n=78 participants (age, 53±13 years; 65% women; body mass index, 37.3±6.8 kg/m 2 ), 40 (51%) met echocardiographic criteria to undergo invasive cardiopulmonary exercise testing. In total, 24 participants (60% among the cardiopulmonary exercise testing group, 31% among the total sample) were diagnosed with HFpEF by rest or exercise pulmonary capillary wedge pressure (n=12) or exercise criteria (n=12). There were no differences in NT-proBNP (N-terminal pro-B-type natriuretic peptide; 79 [62–104] versus 73 [57–121] pg/mL) or resting echocardiography (mitral E/e′ ratio, 9.1±3.1 versus 8.0±2.7) among those with versus without HFpEF ( P >0.05 for all). Distributions of HFpEF diagnostic scores were similar, with the majority classified as intermediate risk (100% versus 93.75% [H 2 FPEF] and 87.5% versus 68.75% [HFA-PEFF (Heart Failure Association Pretest assessment, echocardiography and natriuretic peptide, functional testing, and final etiology)] in those with versus without HFpEF). CONCLUSIONS: Among adults with obesity and dyspnea without known cardiovascular disease, at least a third had clinically unrecognized HFpEF uncovered on invasive cardiopulmonary exercise testing. Clinical, biomarker, resting echocardiography, and diagnostic scores were similar among those with and without HFpEF. These results suggest clinical underdiagnosis of HFpEF among individuals with obesity and dyspnea and highlight limitations of noninvasive testing in the identification of HFpEF.

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NT-proBNP for Risk Prediction in Heart Failure

Cited by 30 publications

References 47 publications

Trending Cardiac Biomarkers During Pregnancy in Women With Cardiovascular Disease

Trending Cardiac Biomarkers During Pregnancy in Women With Cardiovascular Disease

Association between secondhand smoke exposure and incident heart failure: The Multi‐Ethnic Study of Atherosclerosis (MESA)

Uncovering Unrecognized Heart Failure With Preserved Ejection Fraction Among Individuals With Obesity and Dyspnea

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