P1641What is the best BNP cutoff value to rule out or rule in the diagnosis of heart failure in the community?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W A Martins ◽  
A Lagoeiro Jorge ◽  
H Villacorta ◽  
M L G Rosa ◽  
S Chermont ◽  
...  
Keyword(s):  
Heart Failure ◽  
Predictive Value ◽  
Care Program ◽  
Final Diagnosis ◽  
Cross Sectional ◽  
Cutoff Value ◽  
Reduced Ejection Fraction ◽  
Number Of Patients ◽  
Esc Guidelines ◽  
Rule Out

Abstract Background There is no consensus on the cutoff value of B-type natriuretic peptide (BNP) to rule in or rule out the diagnosis of heart failure (HF) in the community. For instance, the ESC guidelines propose a cutoff of 35 pg/mL and the Canadian Guidelines propose 50 pg/mL. Objectives To evaluate the performance of several BNP cutoffs to rule in or rule out the diagnosis of HF in the community. Methods A total of 633 randomly selected individuals, aged 45 to 99 years, of both sexes, enrolled in a primary care program in several regions of a medium-sized city with 487,562 inhabitants were evaluated. A cross-sectional study, in which one-day clinical data collection, laboratory tests, BNP tests and tissue Doppler echocardiogram (TDE) were performed. The final diagnosis of HF was adjudicated by two independent cardiologists. Sensitivity (SEN), specificity (SPE), negative predictive value (NPV) and positive predictive value (PPV) were evaluated for different BNP cutoffs. A ROC curve was used to determine the best cutoff value. Results The mean age was 59.6±10.4 years and 62% were women. The incidence for ACC/AHA HF stages Zero, A, B, C and D were, respectively, 11.8%, 36.3%, 42.6%, 9.3% and 0%. There was a predominance of HF with preserved versus reduced ejection fraction (59% vs 41%). For the identification of the 59 patients with symptomatic HF, the cutoff of 35pg/mL presented SEN 98%, SPE 87%, NPV 100% and PPV 44%. For cutoff of 50pg/mL these values were SEN 78%, SPE 94%, NPV 98% and PPV 58%. The best combination of SEN and SPE was with a cutoff of 42pg/mL (SEN 92% and SPE 91%). Only one patient with HF had BNP<35pg/mL. With the cutoff of 50pg/mL, 13 (22%) of the 59 pts with symptomatic HF would not have been diagnosed. Conclusions The cutoff with higher specificity to rule in the diagnosis of HF was 50pg/mL. However, with this cutoff an expressive number of patients with HF would have been missed. For screening purpose in the community, the best cutoff to rule out HF was 35pg/mL, as proposed in the ESC guidelines

scholarly journals Bruckner Red Light Reflex Test in a Hospital Setting

2013 ◽  
Vol 10 (2) ◽  
pp. 23-26 ◽  
Author(s):  
R Saiju ◽  
S Yun ◽  
PD Yoon ◽  
MK Shrestha ◽  
UD Shrestha
Keyword(s):  
Predictive Value ◽  
Red Light ◽  
Hospital Setting ◽  
Posterior Segment ◽  
Specific Marker ◽  
Cross Sectional ◽  
Light Reflex ◽  
Number Of Patients ◽  
Brückner Test ◽  
Significant Pathology

Background Childhood blindness is a major problem in developing world including Nepal that needs to be addressed. Objective The objective of study was to measure the effectiveness of the Bruckner red reflex test for screening of posterior segment opacities in children. Methods Patients aged less than five years who came to the Tilganga Institute of Ophthalmology, Kathmandu from March to August, 2009 were recruited in this cross-sectional descriptive study. Children were screened with the Bruckner red light reflex test in a dark room. Patients with abnormal Bruckner tests had their eyes dilated for further investigations. Abnormalities were recorded. The number of patients with an abnormal Bruckner test was recorded and correlated with their potential pathology. Results A total of 172 patients with 97 boys and 75 girls were included. Twenty-three had abnormal Bruckner test results in either one or both eyes. Four of these twenty-three patients had no pathology diagnosed; hence the sensitivity of the Bruckner screen to diagnose significant pathology was calculated at 82.6%. Of the 153 patients with normal results, two patients were found to have pathology detected, which included cataract and strabismus. Hence, the specificity of this test was 98.7%. The screening test had a positive predictive value of 90.5% and a negative predictive value of 97.4%. Conclusion Bruckner test screening is a sensitive and specific marker for detecting the posterior segment opacities in children. We recommend utilizing the test to evaluate these problems where other technologies are rare. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 23-26 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7338

scholarly journals EPIDEMILOGICAL, CLINICAL AND ECHOCARDIOGRAPHIC FEATURES OF HEART FAILURE IN MOROCCO

2021 ◽  
Vol 9 (11) ◽  
pp. 521-526
Author(s):  
A. Maliki Alaoui ◽  
◽  
Y. Fihri ◽  
A. Ben El Mekki ◽  
H. Bouzelmat ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Heart Failure ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Cross Sectional ◽  
Reduced Ejection Fraction ◽  
Cardiology Department ◽  
Common Risk Factors ◽  
The Mean

Heart failure (HF) is a major public issue taking an epidemic dimension globally. Its incidence is continuing to rise because of a growing and aging population. We held a cross-sectional retrospective studyin the cardiology department of Mohamed V military teaching hospital of Rabat in morocco fromSeptember 2019 toSeptember 2021, including 104 patients admitted with HF. The mean age was 68.5 ±10.3year. Hypertension and diabetes mellitus are the most common risk factors. HF with reduced ejection fraction represents about 49%. Forty-four percent had dilated cardiomyopathy. Ischemic heart disease is the first cause of HF.

scholarly journals Prognostic value of atrial fibrillation in patients with heart failure and different left ventricular ejection fraction: results of the multicenter RIF-CHF register

2021 ◽  
Vol 26 (1) ◽  
pp. 4200
Author(s):  
I. V. Zhirov ◽  
N. V. Safronova ◽  
Yu. F. Osmolovskaya ◽  
S. N. Тereschenko
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Cardiovascular Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Number Of Patients ◽  
Increased Risk

Heart failure (HF) and atrial fibrillation (AF) are the most common cardiovascular conditions in clinical practice and frequently coexist. The number of patients with HF and AF is increasing every year.Aim. To analyze the effect of clinical course and management of HF and AF on the outcomes.Material and methods. The data of 1,003 patients from the first Russian register of patients with HF and AF (RIF-CHF) were analyzed. The endpoints included hospitalization due to decompensated HF, cardiovascular mortality, thromboembolic events, and major bleeding. Predictors of unfavorable outcomes were analyzed separately for patients with HF with preserved ejection fraction (AF+HFpEF), mid-range ejection fraction (AF+HFmrEF), and reduced ejection fraction (AF+HFrEF).Results. Among all patients with HF, 39% had HFpEF, 15% — HFmrEF, and 46% — HFrEF. A total of 57,2% of patients were rehospitalized due to decompensated HF within one year. Hospitalization risk was the highest for HFmrEF patients (66%, p=0,017). Reduced ejection fraction was associated with the increased risk of cardiovascular mortality (15,5% vs 5,4% in other groups, p<0,001) but not ischemic stroke (2,4% vs 3%, p=0,776). Patients with HFpEF had lower risk to achieve the composite endpoint (stroke+MI+cardiovascular death) as compared to patients with HFmrEF and HFrEF (12,7% vs 22% and 25,5%, p<0,001). Regression logistic analysis revealed that factors such as demographic characteristics, disease severity, and selected therapy had different effects on the risk of unfavorable outcomes depending on ejection fraction group.Conclusion. Each group of patients with different ejection fractions is characterized by its own pattern of factors associated with unfavorable outcomes. The demographic and clinical characteristics of patients with mid-range ejection fraction demonstrate that these patients need to be studied as a separate cohort.

scholarly journals Plasma B-type natriuretic peptide concentration for diagnosis of acute heart failure with renal insufficiency

2016 ◽  
Vol 8 (1) ◽  
pp. 19
Author(s):  
Naila Atik Khan ◽  
Md. Mozammel Hoque ◽  
Subrata Kumar Biswas ◽  
Mohammad Masum Alam ◽  
Mohammad Shahed Ashraf
Keyword(s):  
Heart Failure ◽  
Renal Insufficiency ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Sensitivity And Specificity ◽  
Significant Negative Correlation ◽  
Cross Sectional ◽  
Renal Metabolism ◽  
Cutoff Value ◽  
Medical University

<p><strong>Background :</strong> Plasma B-type natriuretic peptide (BNP) is the diagnostic tool for acute heart failure (AHF).This natriu­retic peptide level depends on renal function, through renal metabolism and excretion. Therefore we examined the effect ofrenal impairment on plasma BNP level during diagnosis of AHF.</p><p><strong>Objective:</strong> The objective of the study was to assess the effect of renal dysfunction on plasma BNP level and to determine appropriate cutoff value of plasma BNP to diagnose the patients of AHF with renal insufficiency.</p><p><strong>Methods:</strong> This cross sectional analytical study was conducted in the Depart­ment of Biochemistry Bangabandhu Sheikh Mujib Medical University (BSMMU). The study was done among 90 AHF patients selected from cardiology emergency department during the period of July 2012 to June 2013. After enrollment plasma BNP concentration was measured and eGFR was estimated from serum creatinine by the four parameter Modifica­tion of Diet and Renal Disease (MORD) equation and then grouped into two groups on the basis of empirical cut off value of eGFR 60 ml/min/1.73 m<sup>2</sup></p><p><strong>Results:</strong> In this study a significant negative correlation was found between plasma BNP evel and eGFR (P&lt;0.001 ), with higher BNP levels observed as eGFR declined. The optimal BNP cutoff value for diagno­sis of AHF patients with renal insufficiency was 824 pg/ml. At this cutoff level AHF with renal insufficiency could be diagnosed with sensitivity and specificity of 84% and 71 %, respectively.</p><p><strong>Conclusions:</strong> By adjusting the cutoff value, plasma BNP can be used to diagnose AHF with renal insufficiency with an acceptable sensitivity and specificity.</p>

scholarly journals Heart Failure is Highly Prevalent and Difficult to Diagnose in Severe Exacerbations of COPD Presenting to the Emergency Department

2020 ◽  
Vol 9 (8) ◽  
pp. 2644
Author(s):  
Mariaenrica Tinè ◽  
Erica Bazzan ◽  
Umberto Semenzato ◽  
Davide Biondini ◽  
Elisabetta Cocconcelli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Retrospective Chart Review ◽  
Care Program ◽  
Final Diagnosis ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Factors Affecting ◽  
Risk Of Death ◽  
Copd Patients

Background: Some 20% of patients with stable Chronic Obstructive Pulmonary Disease (COPD) might have heart failure (HF). HF contribution to acute exacerbations of COPD (AECOPD) presenting to the emergency department (ED) is not well established. Aims: To assess (1) the HF incidence in patients presenting to the ED with AECOPD; (2) the concordance between ED and respiratory ward (RW) diagnosis; (3) the factors associated with risk of death after hospital discharge. Methods: Retrospective chart review of 119 COPD patients presenting to ED for acute exacerbation of respiratory symptoms and then admitted to RW where a final diagnosis of AECOPD, AECOPD and HF and AECOPD and OD (other diagnosis), was obtained. ED and RW diagnosis were then compared. Factors affecting survival at follow-up were investigated. Results: At RW, 40.3% of cases were diagnosed of AECOPD, 40.3% of AECOPD and HF and 19.4% of AECOPD and OD, with ED diagnosis coinciding with RW’s in 67%, 23%, and 57% of cases respectively. At RW, 60% of patients in GOLD1 had HF, of which 43% were diagnosed at ED, while 40% in GOLD4 had HF that was never diagnosed at ED. Lack of inclusion in a COPD care program, HF, and early readmission for AECOPD were associated with mortality. Conclusions: HF is highly prevalent and difficult to diagnose in patients in all GOLD stages presenting to the ED with severe AECOPD, and along with lack of inclusion in a COPD care program, confers a high risk for mortality.

P6472Novel cardiac imaging prognostic markers of clinical outcome in patients with bicuspid aortic valve and chronic aortic regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Kockova ◽  
H Linkova ◽  
Z Hlubocka ◽  
A Praveckova ◽  
A Polednova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Disease Progression ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Early Disease ◽  
Regurgitant Fraction ◽  
Cutoff Value ◽  
Vena Contracta ◽  
Chronic Aortic Regurgitation

Abstract Background Patients with chronic aortic regurgitation (AR) can have a substantial myocardial damage despite being asymptomatic. Early surgical strategy might be beneficial. Bicuspid aortic valve (BAV) is a congenital heart disease present in almost 30% of these patients. Purpose Identify novel imaging predictors of early disease progression. Methods Prospective three-centre study of patients with chronic AR of at least moderate to severe (3+) grade and BAV morphology. Patients without currently recognised indication for surgical treatment were enrolled. Baseline examination included echocardiography (ECHO) with 3-dimensional (3D) vena contracta area and magnetic resonance (MR) with regurgitant fraction measured from flow sequence. All imaging studies were analysed in CoreLab. The primary endpoint was defined as a combination of cardiovascular death, surgical treatment or hospitalization for heart failure. Results A total of 83 patients with BAV and at least 3+ AR were enrolled during 2015–2018. Median follow-up was 759±455 days, primary composite endpoint occurred in 13 patients who met criteria for surgical treatment, no patient died or was hospitalized for heart failure. Baseline parameters were compared between two groups: patients with and without endpoint. Clinical and laboratory data did not differ between the two groups. Left ventricular (LV) ejection fraction was normal in all patients. LV diameters and volumes were significantly larger in patients with primary endpoint. This was most pronounced in MR measured indexed volumes in end-diastole and end-systole, P=0.003 and P=0.003. Non-invasive markers of diffuse myocardial fibrosis (native T1 relaxation time and global longitudinal strain, P=0.614 and P=0.137 respectively) were not different. Novel markers of AR severity were significantly increased in surgically treated patients: 3D vena contracta 0.26±0.10 cm2 versus 0.38±0.11 cm2 (P<0.001), MR regurgitant fraction 33.9±15.4 versus 50.2±12.2% (P=0.001). Both 3D vena contracta with cutoff value ≥0.4 cm2 (sensitivity=85%, specificity=84%, area under the curve=0.85) and MR regurgitant fraction with cutoff value ≥34% (sensitivity=94%, specificity=58%, area under the curve=0.76) showed high accuracy to identify patients who require early surgical intervention. Adding 3D vena contracta and MR regurgitant fraction to indexed LV end-systolic volumetric parameters significantly increases the predictive value for early disease progression with p=0.001 and p=0.006 (Likelihood-ratio test). 3D vena contracta predictive value Conclusions Novel imaging parameters of AR severity such as 3D vena contracta and MR derived regurgitant fraction predict early disease progression in patients with BAV and at least 3+ chronic AR. These values significantly increase the predictive value of traditional parameters based on LV size measures.

scholarly journals Healthy Strut Coverage After Coronary Stent Implantation

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Hiroyuki Jinnouchi ◽  
Fumiyuki Otsuka ◽  
Yu Sato ◽  
Rahul R. Bhoite ◽  
Atsushi Sakamoto ◽  
...  
Keyword(s):  
Predictive Value ◽  
Ex Vivo ◽  
Smooth Muscles ◽  
Cross Sectional ◽  
Cutoff Value ◽  
Neointimal Thickness ◽  
Cutoff Values ◽  
Coronary Stent Implantation ◽  
Stent Strut ◽  
Oct Imaging

Background: Struts have been considered as covered when tissue overlying the struts is >0 μm by optical coherence tomography (OCT). However, there is no confirmatory study to validate this definition by histology which is the gold standard. The aim of the present study was to assess the appropriate cutoff value of neointimal thickness of stent strut coverage by OCT with histology confirmation. Methods: We performed ex vivo OCT imaging of human coronary arteries with stents at autopsy. A total of 46 stents in 39 vessels from 25 patients were examined in this study, and a total of 165 cross-sectional images were co-registered with histology to determine the optimal cutoff value for strut coverage by OCT which was defined as luminal endothelial cells with 2 abluminal layers of smooth muscles cells and matrix. Considering the resolution of OCT is 10 to 20 μm, the cutoff values were assessed at ≥20, ≥40, and ≥60 μm. Results: A total of 2235 struts were reviewed by histology, 1216 were considered as well-matched struts which were analyzed in this study. By histology, 160 struts were identified as uncovered, while 1056 struts were covered. The OCT assessment without consideration of neointimal thickness yielded a poor specificity of 37.5% and sensitivity 100%. Of 3 cutoff values, the cutoff value of ≥40 μm yielded the best sensitivity (99.3%), specificity (91.0%), positive predictive value (98.6%), and negative predictive value (95.6%) as compared with ≥20 and ≥60 μm. Conclusions: Neointimal thickness ≥40 μm by OCT yielded the most accurate cutoff value to identify stent strut coverage validated by histology.

scholarly journals 379 Contemporary use of guideline directed medical therapy in dilated cardiomyopathy: therapeutic optimization and prognostic benefits

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesco Venturelli ◽  
Vincenzo Nuzzi ◽  
Paolo Manca ◽  
Giovanni Santi ◽  
Giulia Barbati ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Dilated Cardiomyopathy ◽  
Beta Blockers ◽  
Recommended Dose ◽  
Target Dose ◽  
Reduced Ejection Fraction ◽  
Number Of Patients

Abstract Aims Therapy with antineurohormonal drugs at target doses has a prognostic benefits in heart failure with reduced ejection fraction. Dilated cardiomyopathy (DCM) represents a particular setting where the possible benefit of target doses of antineurohormonal drugs is unexplored. Methods and results All patients enrolled from 1/1/1992 to 1/3/2020 in the Trieste Muscle Heart Disease register affected by DCM with data on the dosage of therapy available both enrollment and at follow-up visit (i.e., 6–12 month) were included. The population was divided according to the percentage of recommended dose prescribed (0–49%, 50–99%, 100%) of both renin-angiotensin system inhibitors (RASi) and beta blockers (BB). A composite of death/heart transplant/hospitalization for heart failure was considered as the primary endpoint; a composite of sudden cardiac death/major ventricular arrythmias/defibrillator intervention was evaluated as a secondary endpoint. Prognostic associations were explored with uni- and multivariate analyses, Cox regressions, Kaplan–Meier, cumulative incidence curves and propensity score matching. 826 patients were included. At baseline 789 (96%) were taking a RASi and 627 (76%) a BB. The target dose of RASi was prescribed in 29% and 36% of patients at enrolment and at follow-up visit, respectively. The percentage of patients taking the maximum recommended dose of BB was 10% at baseline and 17% after optimization. Predictors of reaching target dose for RASi were BMI &lt; 25 kg/m2, male sex [HR: 1.798 (95% CI: 1.073–3.012), P = 0.026] and higher systolic blood pressure [HR per mmHg 1.038 (95% CI: 1.025–1.051), P &lt; 0.001]. Target dose predictors of BB were age [HR per year 0.527 (95% CI: 0.347–0.802), P = 0.003] and highest systolic blood pressure [HR per mmHg 1.024 (95% CI: 1.013–1.035), P &lt; 0.001]. After adjustment target dose of RASi or BB did not show a significant association with the risk of primary outcome occurrence compared to those taking less than 50% (P = 0.550 for RASi and P = 0.921 for BB). The incidence of arrhythmic events was significantly lower in patients taking 100% of recommended dose of BB compared to those taking less than 50% (P = 0.009), after adjustment for confounders. The target dose of RASi was not associated with an arrhythmic events risk change (P = 0.688). Conclusions In DCM a significant number of patients do not tolerate maximal therapy doses, mainly due to hypotension. The achievement of the target dose of RASi and BB, after adjustment for confounders had a neutral effect on the incidence of heart failure-related events. Uptitration of BB to the recommended dose has a strong protective effect on arrhythmic events.

Sign in / Sign up

Export Citation Format

Share Document