Renal function, N-terminal Pro-B-Type natriuretic peptide, propeptide big-endothelin and patients with heart failure and preserved ejection fraction

Peptides ◽  
2019 ◽  
Vol 111 ◽  
pp. 112-117 ◽  
Author(s):  
Ingrid Gergei ◽  
Bernhard K. Krämer ◽  
Hubert Scharnagl ◽  
Tatjana Stojakovic ◽  
Winfried März
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Natriuretic Peptide ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

Abstract 12849: Changes in N-terminal Pro Brain Natriuretic Peptide Levels Predicts Mortality and Heart Failure Hospitalization in Patients With Heart Failure and Preserved Ejection Fraction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Gianluigi Savarese ◽  
Camilla Hage ◽  
Ulf Dahlström ◽  
Pasquale Perrone-Filardi ◽  
Lars H Lund
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Total Mortality ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
The Impact

Introduction: Changes in N-terminal pro brain natriuretic peptide (NT-proBNP) have been demonstrated to correlate with outcomes in patients with heart failure (HF) and reduced ejection fraction (EF). However the prognostic value of a change in NT-proBNP in patients with heart failure and preserved ejection fraction (HFPEF) is unknown. Hypothesis: To assess the impact of changes in NT-proBNP on all-cause mortality, HF hospitalization and their composite in an unselected population of patients with HFPEF. Methods: 643 outpatients (age 72+12 years; 41% females) with HFPEF (ejection fraction ≥40%) enrolled in the Swedish Heart Failure Registry between 2005 and 2012 and reporting NT-proBNP levels assessment at initial registration and at follow-up were prospectively studied. Patients were divided into 2 groups according the median value of NT-proBNP absolute change that was 0 pg/ml. Median follow-up from first measurement was 2.25 years (IQR: 1.43 to 3.81). Adjusted Cox’s regression models were performed using total mortality, HF hospitalization (with censoring at death) and their composite as outcomes. Results: After adjustments for 19 baseline variables including baseline NT-proBNP, as compared with an increase in NT-proBNP levels at 6 months (NT-proBNP change>0 pg/ml), a reduction in NT-proBNP levels (NT-proBNP change<0 pg/ml) was associated with a 45.2% reduction in risk of all-cause death (HR: 0.548; 95% CI: 0.378 to 0.796; p:0.002), a 50.1% reduction in risk of HF hospitalization (HR: 0.49; 95% CI: 0.362 to 0.689; p<0.001) and a 42.6% reduction in risk of the composite outcome (HR: 0.574; 95% CI: 0.435 to 0.758; p<0.001)(Figure). Conclusions: Reductions in NT-proBNP levels over time are independently associated with an improved prognosis in HFPEF patients. Changes in NT-proBNP could represent a surrogate outcome in phase 2 HFPEF trials.

Abstract 13104: The Concomitant Inflammation Affect the Ratio of N-terminal Pro B-type Natriuretic Peptide to B-type Natriuretic Peptide in Patients With Heart Failure and Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tsutomu Kawai ◽  
Takahisa Yamada ◽  
Tetsuya Watanabe ◽  
Shunsuke Tamaki ◽  
Shungo Hikoso ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Natriuretic Peptide ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Inflammatory Status ◽  
Patients With Heart Failure ◽  
Multicenter Prospective Observational Study

Backgrounds: Although B-type natriuretic peptide (BNP) and N-terminal pro B-type natriuretic peptide (NT-proBNP ) are interrelated parameters in assessment heart failure severity and prognosis, the ratio of NT-proBNP to BNP (NT-proBNP/BNP) are affected by various clinical factors, such as renal function. However, little is known about the influence of inflammation on NT-proBNP/BNP in patients with heart failure and preserved ejection fraction (HFpEF). Methods and Results: Patients data were extracted from PURSUIT-HFpEF registry, which is a multicenter prospective observational study including patients hospitalized for acute heart failure with left ventricular ejection fraction of >50%. Of 871 patients, data of BNP and NT-proBNP was available in 654 patients. The median baseline concentration of BNP was 474 pg/ml (299-720), NT-proBNP was 3310 pg/ml (1740-6840), and NT-proBNP/BNP was 7.6 (5.0-11.8). In multivariable linear regression analyses, older age [odds ratio (OR); 1.05, 95% confidence interval (CI); 1.02-1.09, p=0.001], higher creatinine [OR; 2.63, 95% CI; 1.66-4.16, p<0.001], and higher C-reactive protein (CRP) [OR; 1.17, 95% CI; 1.06-1.28, p<0.001] were significantly associated with a higher NT-proBNP/BNP (>median value of 7.6). However, other factors expected to affect NT-proBNP/BNP, such as atrial fibrillation and body mass index, were not associated with a higher NT-proBNP/BNP in this study. Patients in the highest CRP quartile had significantly higher NT-proBNP/BNP than those with other quartiles. Conclusion: In HFpEF patients, concomitant inflammation was associated with high NT-proBNP/BNP, which indicated that we need a careful interpretation on these two natriuretic peptides of patients with HFpEF and inflammatory status, such as infection.

scholarly journals Hyperaldosteronemia as a risk factor of renal dysfunction in patients with heart failure with preserved ejection fraction

2020 ◽  
Vol 48 (5) ◽  
pp. 316-324
Author(s):  
A. N. Shevelok
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Plasma Level ◽  
Confidence Interval ◽  
Ejection Fraction ◽  
Odds Ratio ◽  
Plasma Aldosterone ◽  
Preserved Ejection Fraction ◽  
Increased Risk ◽  
Patients With Heart Failure

Objective: To assess the relationship between plasma aldosterone levels and renal function in patients with heart failure with preserved ejection fraction (HFpEF).Materials and methods: A cross-sectional study included 158 patients with confirmed HFpEF. Patients with primary hyperaldosteronism, edema syndrome, end stage renal disease and taking mineralocorticoid receptor antagonists were excluded. Renal function was assessed by determining daily urinary albumin excretion (UAE) and calculating the glomerular filtration rate (GFR). Plasma aldosterone was measured by enzyme immunoassay.Results: The patients were divided into two groups: 99 patients had normal (40-160 pg/ml) aldosterone plasma level (nAld) and 59 patients had high (> 160 pg/ml) aldosterone level (hAld). hAld patients had significantly higher UAE (median 342 mg/day [interquartile value 253; 453] versus 116 mg/day [32; 255], p < 0.001), and lower GFR (52 ml/min/1.73 m2 [46; 67.5] versus 66 ml/min/1.73 m2 [53; 79]) compared to nAld. The prevalence of impaired renal filtration function and severe albuminuria was higher in hAld group then in nAld (p < 0.001). In binomial logistic regression models adjusted for age, severity of HFpEF and comorbidities high aldosterone plasma level were independent risk factors of significant (< 60 ml/min/1.73 m2) decrease in GFR (odds ratio 4.25, 95% confidence interval 2.01-16.6) and very high (> 300 mg/day) albuminuria (odds ratio 2.23, 95% confidence interval 1.24-9.63).Conclusion: In HFpEF plasma aldosterone levels are closely related to renal function. Secondary hyperaldosteronism is associated with an increased risk of impaired renal filtration and severe albuminuria.

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