Superior performance of N‐terminal pro brain natriuretic peptide for diagnosis of acute decompensated heart failure in an Asian compared with a Western setting

Ibrahim, Irwani; Kuan, Win Sen; Frampton, Chris; Troughton, Richard W.; Liew, Oi Wah; Chong, Jenny; Chan, Siew Pang; Tan, Li; Lin, Wei; Pemberton, Chris J.; Ooi, Shirley Beng Suat; Richards, A. Mark

doi:10.1002/ejhf.612

Cited by 37 publications

(48 citation statements)

References 19 publications

(26 reference statements)

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“…12 Nevertheless, discriminatory power of NT-proBNP for acute HF is superior in Asian acute HF patients than in Caucasian acute HF patients in the emergency department. 13 NT-proBNP levels were similar in our study between Asian and Caucasian patients despite differences in distribution of key drivers of NT-proBNP levels between Asians such as atrial fibrillation and BMI. This suggests that, overall, the drivers of NT-proBNP levels were balanced between Asian and Caucasian HF patients and that NT-proBNP is similarly prognostic irrespective of the exact combination and proportional magnitude of drivers for production and clearance of plasma NT-proBNP concentrations.…”

Section: Discussionsupporting

confidence: 59%

“…Clinical determinants of BNP levels have been previously found to be relatively similar across ethnicities 12. Nevertheless, discriminatory power of NT‐proBNP for acute HF is superior in Asian acute HF patients than in Caucasian acute HF patients in the emergency department 13. NT‐proBNP levels were similar in our study between Asian and Caucasian patients despite differences in distribution of key drivers of NT‐proBNP levels between Asians such as atrial fibrillation and BMI.…”

Section: Discussionsupporting

confidence: 44%

“…A recent study showed that Asian‐American and African‐American HF patients have higher BNP levels than did their Caucasian peers and that predictive value for in‐hospital mortality was similar between ethnicities in an acute HF population 12. Furthermore, NT‐proBNP had higher discriminatory power for identifying HF in Asian dyspnoeic individuals in the emergency department than in Caucasian dyspnoeic individuals 13. However, no previous reports compare results from multi‐ethnic populations with those from stable HF in Asian and Western settings.…”

Section: Introductionmentioning

confidence: 99%

“…12 Furthermore, NT-proBNP had higher discriminatory power for identifying HF in Asian dyspnoeic individuals in the emergency department than in Caucasian dyspnoeic individuals. 13 However, no previous reports compare results from multi-ethnic populations with those from stable HF in Asian and Western settings. Therefore, we report the clinical associations and prognostic performance of NT-proBNP in Asian and Caucasian patients with chronic HF.…”

Section: Introductionmentioning

confidence: 99%

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N‐terminal pro‐B‐type natriuretic peptide and prognosis in Caucasian vs. Asian patients with heart failure

et al. 2018

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AimsN‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is the most frequently used biomarker in heart failure (HF), but its prognostic utility across ethnicities is unclear.Methods and resultsThis study included 546 Caucasians with HF from the Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure and 578 Asians with HF from the Singapore Heart Failure Outcomes and Phenotypes study. NT‐proBNP was measured at discharge after HF hospitalization. The studied outcome was a composite of all‐cause mortality and HF hospitalization at 18 months. Compared with Caucasian patients, Asian patients were younger (63 ± 12 vs. 71 ± 11 years); less often female (26% vs. 39%); and had lower body mass index (26 vs. 27 kg/m2), better renal function (61 ± 37 vs. 54 ± 20 mL/min/1.73 m2), lower rates of atrial fibrillation (25% vs. 46%), strikingly higher rates of diabetes (59% vs. 30%), and higher rates of hypertension (76% vs. 44%). Despite these clear inter‐group differences in individual drivers of NT‐proBNP, average levels were similar in Asians [2709 (1350, 6302) pg/mL] and Caucasians [2545 (1308, 5484) pg/mL] (P = 0.514). NT‐proBNP was strongly associated with outcome [hazard ratio 1.28 (per doubling), 95% confidence interval 1.18–1.39, P < 0.001], regardless of ethnicity (P interaction = 0.719). NT‐proBNP was similarly associated with outcome in HF with reduced and preserved ejection fraction in Asian (P interaction = 0.776) and Caucasian patients (P interaction = 0.558).ConclusionsNT‐proBNP has similar prognostic performance in Asians and Caucasians with HF despite ethnic differences in known clinical determinants of plasma NT‐proBNP.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionsupporting

confidence: 44%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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N‐terminal pro‐B‐type natriuretic peptide and prognosis in Caucasian vs. Asian patients with heart failure

et al. 2018

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“…Comparisons of HF prediction scores in Asian vs. Western settings are lacking. In a recent study, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) showed superior discriminative capacity in an Asian compared to a New Zealand HF cohort . We therefore aimed to evaluate the effectiveness of EHFS in risk stratification in an Asian cohort of systolic HF patients.…”

Section: Introductionmentioning

confidence: 99%

Risk stratification of Asian patients with heart failure and reduced ejection fraction: the effectiveness of the Echo Heart Failure Score

Bosch

Carluccio

Coiro

et al. 2017

European J of Heart Fail

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Extracellular vesicle Cystatin C and CD14 are associated with both renal dysfunction and heart failure

et al. 2020

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Aims Extracellular vesicles (EVs) are small double-membrane plasma vesicles that play key roles in cellular crosstalk and mechanisms such as inflammation. The role of EVs in combined organ failure such as cardiorenal syndrome has not been investigated. The aim of this study is to identify EV proteins that are associated with renal dysfunction, heart failure, and their combination in dyspnoeic patients. Methods and results Blood samples were prospectively collected in 404 patients presenting with breathlessness at the emergency department at National University Hospital, Singapore. Renal dysfunction was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m 2. The presence of heart failure was independently adjudicated by two clinicians on the basis of the criteria of the European Society of Cardiology guidelines. Protein levels of SerpinG1, SerpinF2, Cystatin C, and CD14 were measured with a quantitative immune assay within three EV sub-fractions and in plasma and were tested for their associations with renal dysfunction, heart failure, and the concurrence of both conditions using multinomial regression analysis, thereby correcting for confounders such as age, gender, ethnicity, and co-morbidities. Renal dysfunction was found in 92 patients (23%), while heart failure was present in 141 (35%). In total, 58 patients (14%) were diagnosed with both renal dysfunction and heart failure. Regression analysis showed that Cystatin C was associated with renal dysfunction, heart failure, and their combination in all three EV sub-fractions and in plasma. CD14 was associated with both renal dysfunction and the combined renal dysfunction and heart failure in all EV sub-fractions, and with presence of heart failure in the high density lipoprotein sub-fraction. SerpinG1 and SerpinF2 were associated with heart failure in, respectively, two and one out of three EV sub-fractions and in plasma, but not with renal dysfunction. Conclusions We provide the first data showing that Cystatin C and CD14 in circulating EVs are associated with both renal dysfunction and heart failure in patients presenting with acute dyspnoea. This suggests that EV proteins may be involved in the combined organ failure of the cardiorenal syndrome and may represent possible targets for prevention or treatment.

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Superior performance of N‐terminal pro brain natriuretic peptide for diagnosis of acute decompensated heart failure in an Asian compared with a Western setting

Abstract: Considering emerging evidence of a lower average age of presentation with ADHF over most of Asia compared with Western countries, NT-proBNP is likely to be more accurate when applied in Asian centres than in the West.

Cited by 37 publications

References 19 publications

N‐terminal pro‐B‐type natriuretic peptide and prognosis in Caucasian vs. Asian patients with heart failure

N‐terminal pro‐B‐type natriuretic peptide and prognosis in Caucasian vs. Asian patients with heart failure

Risk stratification of Asian patients with heart failure and reduced ejection fraction: the effectiveness of the Echo Heart Failure Score

Extracellular vesicle Cystatin C and CD14 are associated with both renal dysfunction and heart failure

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