BNP in children with congenital cardiac disease: is there now sufficient evidence for its routine use?

2015 ◽  
Vol 25 (3) ◽  
pp. 424-437 ◽  
Author(s):  
Massimiliano Cantinotti ◽  
Henry L. Walters ◽  
Maura Crocetti ◽  
Marco Marotta ◽  
Bruno Murzi ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Point Of Care ◽  
Multivariable Analysis ◽  
Prognostic Indicator ◽  
Sufficient Evidence ◽  
Blood Specimens ◽  
The Individual

AbstractInterest in brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in the management of children with CHD has increased. There are, however, no current guidelines for their routine use. The aim of this review article is to provide an update on the data regarding the use of BNP/NT-proBNP in the evaluation and surgical treatment of children with CHD. BNP/NT-proBNP levels in children with CHD vary substantially according to age, laboratory assay methods, and the specific haemodynamics associated with the individual congenital heart lesion. The accuracy of BNP/NT-proBNP as supplemental markers in the integrated screening, diagnosis, management, and follow-up of CHD has been established. In particular, the use of BNP/NT-proBNP as a prognostic indicator in paediatric cardiac surgery has been widely demonstrated, as well as its role in the subsequent follow-up of surgical patients. Most of the data, however, are derived from single-centre retrospective studies using multivariable analysis; prospective, randomised clinical trials designed to evaluate the clinical utility and cost-effectiveness of routine BNP/NT-proBNP use in CHD are lacking. The results of well-designed, prospective clinical trials should assist in formulating guidelines and expert consensus recommendations for its use in patients with CHD. Finally, the use of new point-of-care testing methods that use less invasive sampling techniques – capillary blood specimens – may contribute to a more widespread use of the BNP assay, especially in neonates and infants, as well as contribute to the development of screening programmes for CHD using this biomarker.

scholarly journals Association of Brain Natriuretic Peptide With Mortality in Exceptionally Long-Lived Families

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 211-211
Author(s):  
Allison Kuipers ◽  
Robert Boudreau ◽  
Mary Feitosa ◽  
Angeline Galvin ◽  
Bharat Thygarajan ◽  
...  
Keyword(s):  
Older Adults ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Sex Education ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Time To Event ◽  
Healthy Older Adults ◽  
Secondary Analyses

Abstract Natriuretic peptides are produced within the heart and released in response to increased chamber wall tension and heart failure (HF). N-Terminal prohormone Brain Natriuretic Peptide (NT-proBNP) is a specific natriuretic peptide commonly assayed in persons at risk for HF. In these individuals, NT-proBNP is associated with future disease prognosis and mortality. However, its association with mortality among healthy older adults remains unknown. Therefore, we determined the association of NT-proBNP with all-cause mortality over a median follow-up of 10 years in 3253 individuals free from HF at baseline in the Long Life Family Study, a study of families recruited for exceptional longevity. We performed cox proportional hazards analysis (coxme in R) for time-to event (mortality), adjusted for field center, familial relatedness, age, sex, education, smoking, alcohol, physical activity, BMI, diabetes, hypertension, and cancer. In addition, we performed secondary analyses among individuals (N=2457) within the normal NT-proBNP limits at baseline (<125pg/ml aged <75 years; <450pg/ml aged ≥75 years). Overall, individuals were aged 32-110 years (median 67 years; 44% male), had mean NT-proBNP of 318.5 pg/ml (median 91.0 pg/ml) and 1066 individuals (33%) died over the follow-up period. After adjustment, each 1 SD greater baseline NT-proBNP was associated with a 1.30-times increased hazard of mortality (95% CI: 1.24-1.36; P<0.0001). Results were similar in individuals with normal baseline NT-proBNP (HR: 1.21; 95% CI: 1.11-1.32; P<0.0001). These results suggest that NT-proBNP is a strong and specific biomarker for mortality in older adults independent of current health status, even in those with clinically-defined normal NT-proBNP.

scholarly journals Evaluation of point-of-care testing for brain natriuretic peptide in the out-patient clinic

2015 ◽  
Vol 24 ◽  
pp. S79
Author(s):  
M. Matthews ◽  
R. Doughty ◽  
H. McGrinder ◽  
J. Hannah ◽  
A. Meisner
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Point Of Care ◽  
Point Of Care Testing

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.

scholarly journals Patterns and Predictors of Emicizumab Adherence in People with Hemophilia

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2178-2178
Author(s):  
Ang Li ◽  
Catlin Goodfriend ◽  
John Sokol ◽  
Rebecca Kruse-Jarres
Keyword(s):  
Clinical Trials ◽  
Half Life ◽  
Clinical Care ◽  
Multivariable Analysis ◽  
Skewed Distribution ◽  
Prior Exposure ◽  
Age Group ◽  
Active Inhibitor ◽  
Routine Prophylaxis

Introduction: Emicizumab is a subcutaneously administered, humanized bispecific monoclonal antibody that is recently approved for hemostatic prophylaxis in people with hemophilia A (PWH) with or without factor VIII inhibitors. We hypothesize that the new route and frequency of administration would lead to better treatment adherence compared to factor or bypass products in PWH outside of clinical trials. We performed the current study to test the hypothesis and to examine potential predictors of non-adherence associated with emicizumab treatment. Methods: We performed a retrospective cohort study at the Washington Center for Bleeding Disorders. Inclusion criteria included PWH with moderate to severe hereditary hemophilia (FVIII <5%), clinician recommendation for routine prophylaxis, receipt of clinical care and medication from a hemophilia treatment center (HTC), at least 12 months of prior exposure to factor or bypass products, and at least 3 months of emicizumab treatment. For patients who were previously enrolled in emicizumab clinical trials, adherence data were collected from the time of first commercial product administration. Adherence percentage (%) was estimated as days of drug dispensed / days elapsed x 100 and non-adherence % was determined as 100 - adherence %. Relevant patient, condition, treatment, and socioeconomic variable data were collected from review of medical records. To assess the difference in drug adherence, we compared the adherence % of emicizumab versus that of factor or bypass product in the same patients using the paired t test. To assess predictors of non-adherence %, we used a generalized linear model (GLM) with log link and gamma distribution to account for the right skewed distribution of the outcome. A multivariable GLM was built to incorporate the most significant predictors of non-adherence. Results: We identified 56 PWH that initiated commercial emicizumab from 1/2018 to 5/2019 at our HTC. Five patients were excluded for fewer than 3 months of follow-up on treatment and 3 patients were excluded for not having prior exposure to factor therapy. The remaining 48 patients had a median duration on emicizumab of 7 months (IQR 5-9) at the time of study. The most common dosing frequency was weekly administration (77%). The median age at treatment index date was 17 years (IQR 9-36), 65% were Caucasian, and 46% had Medicaid or Medicare insurance. The majority of patients had a diagnosis of severe hemophilia (90%), 42% had a history of inhibitor (15% active inhibitor), and 25% were previously enrolled in an emicizumab interventional trial. Prior to emicizumab initiation, 46% of patients had 5 or more self-reported annualized bleeds. The most common reason for emicizumab initiation was patient preference (35%), followed by breakthrough bleeding (33%), difficult venipuncture (21%), and shortened factor half-life (10%). Among 12 patients who previously received only on demand treatment, their adherence on emicizumab was 89%. Among 36 patients who previously received routine prophylaxis, their adherence was significantly higher on emicizumab (98%) than factor/bypass products (89%) (p=0.002). Specifically, 18 out of 48 patients (38%) had factor/bypass adherence <75% (or refused prophylaxis) and 2 out of 48 patients (4%) had emicizumab adherence <75%. Various factors were associated with increased emicizumab non-adherence (Table 1). Age group had the strongest association where young and older adult PWH had more non-adherence % than children and adolescents (Figure 1). On multivariable analysis, age group, active inhibitor, and prior factor/bypass agent non-adherence (episodic or <75% usage) were significantly associated with increased emicizumab non-adherence. Conclusions: In the current study, we found that PWH requiring routine prophylaxis were more likely to be adherent to emicizumab than previous factor or bypass agents. Age group (young adult), active inhibitor, and prior non-adherence to factor product were significant predictors for decreased emicizumab adherence but the differences were small. Given the long half-life of the drug, the significance of non-perfect adherence on bleeding outcomes needs to be studied prospectively with longer clinical follow-up. Disclosures No relevant conflicts of interest to declare.

scholarly journals N-terminal Pro-brain Natriuretic Peptide plasma levels are Associated With a Short-Term Diagnosis of Cancer in Patients with Coronary Artery Disease

2020 ◽  
Author(s):  
José Tuñón ◽  
Álvaro Aceña ◽  
Ana Pello ◽  
Sergio Ramos-Cillán ◽  
Juan Martínez-Milla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Plasma Levels ◽  
High Sensitivity ◽  
Short Term ◽  
Artery Disease

Abstract Background N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels are increased in patients with cancer. In this paper we test whether NT-proBNP may identify patients who are going to receive a future cancer diagnosis (CD) in the short term. Methods We studied 962 patients with stable coronary artery disease and free of cancer and heart failure at baseline. NT-proBNP, galectin-3, monocyte chemoattractant protein-1, high-sensitivity C-reactive protein, high-sensitivity cardiac troponin I (hsTnI), and calcidiol (vitamin D) plasma levels were assessed. The primary outcome was new CD. Results After 5.40 (2.81-6.94) years of follow-up, 59 patients received a CD. NT-proBNP [HR 1.036 CI (1.015-1.056) per increase in 100 pg/ml; p=0.001], previous atrial fibrillation [HR 3.140 CI (1.196-8.243); p=0.020], and absence of previous heart failure [HR 0.067 CI (0.006-0.802); p=0.033] were independent predictors of a receiving a CD in first three years of follow-up. None of the variables analyzed predicted a CD beyond this time. A previous history of heart failure was present in 3.3% of patients receiving a CD in the first three years of follow-up, in 0.0% of those receiving this diagnosis beyond three years, and in 12.3% of patients not developing cancer (p=0.036). Conclusions In patients with coronary artery disease, NT-proBNP is an independent predictor of CD in the first three years of follow-up but not later, suggesting that it could be detecting subclinical undiagnosed cancers. The existence of previous heart failure does not account for these differences. New studies in large populations are needed to confirm these findings.

Application of preoperative brain natriuretic peptide levels in clinical practice

Vascular ◽  
2013 ◽  
Vol 21 (4) ◽  
pp. 225-231 ◽  
Author(s):  
Marlin Wayne Causey ◽  
Derek P McVay ◽  
Morohunranti Oguntoye ◽  
Charles Andersen ◽  
Niten Singh
Keyword(s):  
Clinical Practice ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Multivariable Analysis ◽  
Arterial Disease ◽  
Cardiac Complications ◽  
Postoperative Risk ◽  
Receiver Operator Curve Analysis ◽  
Artery Disease ◽  
Peripheral Arterial

The purpose of the study was to determine the clinical utility and practical application of preoperative brain natriuretic peptide (BNP) levels. This is a retrospective review of operating room procedures from November 2006 to March 2009. Preoperative history and physical were reviewed and BNP laboratory levels obtained prior to all procedures and the postoperative course reviewed for incidence of 30-day cardiac complications. A receiver operator curve analysis demonstrated that a preoperative BNP threshold ≥95.5 pg/mL correctly identified 75% of patients with cardiac complications and values ≤18.5 pg/mL identified 100% of patients without adverse postoperative cardiac complications. Multivariable analysis also revealed a history of peripheral arterial disease as the most significant preoperative predictor of cardiac complications followed by BNP above the threshold (odds ratio = 3.7), hypothyroidism, coronary artery disease and prior myocardial infarction. In conclusion, preoperative BNP levels are a useful adjunct in clinical practice to help identify those patients with a high postoperative risk and those with a minimal postoperative risk.

scholarly journals N-terminal pro-brain natriuretic peptide and high-sensitivity troponin T exhibit additive prognostic value for the outcome of critically ill patients

2018 ◽  
Vol 9 (5) ◽  
pp. 496-503 ◽  
Author(s):  
Max Lenz ◽  
Konstantin A Krychtiuk ◽  
Georg Goliasch ◽  
Klaus Distelmaier ◽  
Johann Wojta ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mortality Rate ◽  
Brain Natriuretic Peptide ◽  
Critically Ill ◽  
Natriuretic Peptide ◽  
Critically Ill Patients ◽  
Plasma Levels ◽  
Troponin T ◽  
High Sensitivity ◽  
The Individual

Background: Patients treated at medical intensive care units suffer from various pathologies and often present with elevated troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Both markers may reflect different forms of cardiac involvement in critical illness. Therefore, the aim of our study was to examine the synergistic prognostic potential of NT-proBNP and high-sensitivity TnT (hs)TnT in unselected critically ill patients. Methods: We included all consecutive patients admitted to our intensive care unit within one year, excluding those suffering from acute myocardial infarction or undergoing cardiac surgery and measured NT-proBNP and TnT plasma levels on the day of admission and 72 hours thereafter. Results: Of the included 148 patients, 52% were male, mean age was of 64.2 ± 16.8 years and 30-day mortality was 33.2%. Non-survivors showed significantly higher NT-proBNP and TnT plasma levels as compared with survivors ( p<0.01). An elevation of both markers exhibited an additive effect on mortality, as those with both NT-proBNP and TnT levels above the median had a 30-day mortality rate of 51.0%, while those with both markers below the median had a 16.7% mortality rate (hazard ratio 3.7). These findings were independent of demographic and clinical parameters ( p<0.05). Conclusions: Our findings regarding the individual predictive properties of NT-proBNP and TnT are in line with literature. However, we were able to highlight that they exhibit additive prognostic potential which exceeds their individual value. This might be attributed to a difference in underlying pathomechanisms and an assessment of synergistic risk factors.

Abstract 17200: Plasma BNP Declines in the First Two Years After Transplant and is Elevated at the Time of Treated Rejection

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Tom J Valikodath ◽  
Neal Jorgensen ◽  
Erin Albers ◽  
Borah Hong ◽  
Joshua Friedland-Little ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Ventricular Dysfunction ◽  
Multivariable Analysis ◽  
Wall Stress ◽  
Ventricular Wall ◽  
The Relationship ◽  
Pediatric Recipients ◽  
Over Time

Introduction: Plasma B-type natriuretic peptide (BNP) is a biomarker used to diagnose and monitor ventricular dysfunction and heart failure. However, the response of the allograft to produce BNP from ventricular wall stress and inflammation may be different, particularly in an understudied population such as pediatric recipients. Hypothesis: BNP levels decrease over time after transplant as the allograft recovers; but BNP will be higher during rejection. Methods: Enrolled all heart recipients from January 2007 to December 2016. Rejection surveillance included serial echocardiography, annual biopsy, and BNP q 1-3 months. Rejection is defined as requiring augmentation of immunosuppression from biopsy grade ≥ 2R or ≥ pAMR2 or from clinical diagnosis. Results: Among 114 patients studied, 60% were male with age at transplant 5.8 ± SD 6.5 yrs. Follow-up was 3.7 ± 2.7 yrs and 37 patients (32%) experienced 75 episodes of rejection. A total of 8358 BNP samples were obtained. BNP decreased linearly after transplant leveling off after 2 years (Fig 1). BNP was 671 ± 1115 (n=75) at rejection vs. 187 ± 423 pg/mL (n=501) without rejection confirmed by biopsy. By multivariable analysis, Ln BNP was associated with rejection (RR 1.56; 95% CI 1.35-1.80). Figure 2 shows the relationship between change in BNP and risk of rejection. Multivariable longitudinal Cox proportional model incorporating BNPs leading to 1 st rejection showed Ln BNP to be associated with rejection (HR 2.22; 95% CI 1.53-3.23, p<0.001). Conclusion: BNP continues to decrease in the 1 st 2 years after transplant. At rejection, BNP is elevated, and this test can be further developed to screen for rejection.

P4454N-terminal pro-brain natriuretic peptide and resistance to chronic therapy with 75 mg acetylsalicylic acid assessed by point-of-care test - prospective single center study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K M Cygulska ◽  
Ł Figiel ◽  
D Slawek ◽  
A Karzkowiak ◽  
M Wraga ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Secondary Prevention ◽  
Brain Natriuretic Peptide ◽  
Acetylsalicylic Acid ◽  
Natriuretic Peptide ◽  
Predictive Value ◽  
Independent Predictor ◽  
Point Of Care ◽  
Left Ventricular ◽  
Left Ventricular Ejection

Abstract Background Acetylsalicylic acid (ASA) remains the principal medication for secondary prevention of atherosclerotic complications. Resistance to ASA (ASAres) is multifactorial and results in insufficient reduction of platelet reactivity through incomplete inhibition of thromboxane A2 (TXA2) synthesis. There is controversy regarding the optimal preventive ASA dose with common daily use of 75 mg in many European countries. Purpose The aim of our study is to reassess the prevalence and predictors of ASAres in contemporary cohort of coronary disease (CAD) patients (pts) on stable therapy with 75 mg ASA. Methods We studied 205 patients (36,6% females) with stable CAD and concomitant atherosclerotic disease history (ischemic stroke 10,2%, peripheral vascular disease 8,3%,) and type 2 diabetes in 39,5% on stable regimen 75 mg ASA for a minimum of 1 month (mean age 68,2±9,7 years, mean BMI 27,3±4,7 kg/m2). ASAres was defined as ARU (aspirin reaction unit) ≥550 using point-of-care VerifyNow Aspirin test. Exclusion criteria were: recent (up to 2 months) acute coronary syndrome, cancer, dermatological disease, epilepsy or other chronic neurological diseases, exacerbation of allergic disease, rheumatoid arthritis, periodontal disease, alcoholism, drug addiction, vegetarianism, veganism and other specific diets, and known thrombophilia. The population received standard concomitant preventive treatments including RAA blockade in 88,3%, beta-blockers in 85,9%, statins in 93,2%, and proton pump inhibitors (PPI) in 65,4%. History of infarction was present in 37% and mean left ventricular ejection fraction was 47% (18–75%). Results ASAres was detected in 11,7% of patients. Modest but significant correlations (Spearman's coefficient of rank correlation rho) were detected between ARU and C-reactive protein (CRP) (rs=0,15; p=0,030), N-terminal pro-brain natriuretic peptide (NT-proBNP) (rs=0,15; p=0,039), body weight (rs=0,22; p=0,0014), BMI (rs=0,207, p=0,0029). No significant differences in ASAres we found with regard to sex, other risk factors or concomitant medication, including PPI. However, in ASAres pts median concentrations of NT-proBNP were significantly higher (median 311 vs. 646pg/ml; p=0,046). In multivariate analysis NT-proBNP emerged as the only independent predictor of ASAres (AUC=0,626; p=0,027 with threshold value of 327,3 pg/ml resulting with negative predictive value of 16,98% and positive predictive value of 93,95% for ASAres). Conclusion ASAres has significant prevalence in this secondary prevention CAD cohort treated with 75 mg daily dose. NT-proBNP was identified as the only independent predictor in multivariate analysis. This finding may be important especially for pts with heart failure of ischemic etiology. The implications of switching into 100 mg or higher ASA doses remain to be investigated. Acknowledgement/Funding study was supported from unrestricted research grant from Aflofarm SA

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