Surrogate End Points in Heart Failure

2002 ◽  
Vol 36 (3) ◽  
pp. 479-488 ◽  
Author(s):  
Craig R Lee ◽  
Kirkwood F Adams ◽  
J Herbert Patterson
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Drug Development ◽  
Disease Progression ◽  
Natriuretic Peptide ◽  
Cardiac Remodeling ◽  
Left Ventricular ◽  
Response To Therapy ◽  
End Points ◽  
End Diastolic Volume

OBJECTIVE: To describe the potential utility of a true surrogate marker of heart failure outcomes, historically investigate the validity of surrogates most commonly evaluated in heart failure, and identify specific end points offering the most potential for future use. DATA SOURCES: A MEDLINE search (1966–June 2001) was completed to identify relevant literature. Additional references were also retrieved from selected articles. Search terms included b-type natriuretic peptide, cardiac remodeling, end-diastolic volume, heart failure, and surrogate end points. DATA SYNTHESIS: By definition, true surrogate end points must predict outcomes associated with disease progression and response to therapy. A validated surrogate measure of mortality would render significant utility in both heart failure drug development and clinical practice. Improvements in traditional functional markers of heart failure, including ejection fraction and exercise capacity, have produced inconsistent results in regard to mortality in a number of clinical trials. Numerous measures of cardiac remodeling and neurohormonal activation, however, have proven to be reliable predictors of disease progression and therapeutic response. These findings have contributed significantly to the current understanding of heart failure pathophysiology and approach to treatment. Specifically, measures such as left-ventricular end-diastolic volume (LVEDV) and, potentially, b-type natriuretic peptide (BNP) concentrations may correlate with disease progression and parallel the mortality reductions observed with angiotensin-converting enzyme inhibitor and β-blocker therapy. CONCLUSIONS: Currently, LVEDV and plasma BNP offer the greatest potential as surrogate end points in heart failure. Further investigation of these measures is required before routine implementation in drug development and clinical practice can be justified.

scholarly journals Az N-terminális pro-B natriureticus peptid mérésének korai ismétlése akut szívelégtelenség miatt hospitalizált betegeken

2018 ◽  
Vol 159 (25) ◽  
pp. 1009-1012
Author(s):  
János Tomcsányi ◽  
Miklós Somlói ◽  
Béla Bózsik ◽  
Tamás Frész ◽  
Erzsébet Nagy
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Troponin T ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Response To Therapy ◽  
Prospective Data

Abstract: Introduction: The determination of natriuretic peptide levels in patients hospitalized for suspected acute heart failure is important for the confirmation of the diagnosis and for the prognosis. Changes in natriuretic peptide levels in response to therapy have a strong prognostic value. Aim: To decide whether repeated natriuretic peptide measurements for acute heart failure show changes that could influence the diagnosis and/or the prognosis. Method: Prospective data collection was carried out of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels on admission and within 12 hours in patients hospitalized for acute heart failure. Only the data of those patients were analyzed whose symptoms started within 24 hours prior to admission and were due to acute heart failure. Results: The 23 patients whose data we analyzed had an average age of 77.9 ± 8.3 years. Most of them had left ventricular systolic dysfunction with an average ejection fraction of 34.1 ± 3.9%. The time between the start of symptoms and the first measurement was 6.7 ± 2.2 hours, while the time until the repeated determination was 6.5 ± 2.2 hours after the first measurement. The median value of the NT-proBNP levels in the 6 hours control showed an increase from 5064 pg/mL to 8847 pg/mL (p<0.0005), which amounts to a 75 percent increase – mean hs-troponin T showed an increase from 46 ± 25 ng/L to 78 ± 51 ng/L (p<0.002). Conclusions: A significant increase in NT-proBNP levels is to be expected in early repeated measurement after hospital admission. This fact could have diagnostic and prognostic consequences if validated in a larger patient population. Orv Hetil. 2018; 159(25): 1009–1012.

Brain Type Natriuretic Peptide

2008 ◽  
Vol 27 (5) ◽  
pp. 343-346 ◽  
Author(s):  
Patricia Nash
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Transplant Rejection ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Preterm Neonates ◽  
Term Infants ◽  
End Diastolic Volume ◽  
Ventricular Diastolic Dysfunction ◽  
Near Term

BRAIN TYPE NATRIURETIC PEPTIDE, also called B-type natriuretic peptide (BNP), has emerged as a valuable diagnostic and prognostic marker in the assessment of heart failure in adults.1–7 Serum BNP levels have also been shown to differentiate pulmonary from cardiac causes of dyspnea and to be useful as a screening tool for ventricular hypertrophy, ventricular diastolic dysfunction, transplant rejection, and risk for sudden death in adult patients with congestive heart failure (CHF).3,7,8 In pediatric patients, BNP levels have been found to increase with a hemodynamically significant ventricular septal defect and to correlate with the volume of the shunt and the left ventricular end diastolic volume.7 Recently, BNP levels have been investigated for use in determining the hemodynamic significance of a patent ductus arteriosus (PDA) in preterm neonates.3,7,9–11 They have also been studied for use in the diagnosis and management of persistent pulmonary hypertension in term and near-term infants.6 This article reviews BNP terminology, structure, physiology, measurement, and potential utility in the NICU.

597 Can we use BNP and NTproBNP to rule out heart failure in clinical practice? Results of the UK natriuretic peptide study

2003 ◽  
Vol 2 (1) ◽  
pp. 131
Author(s):  
A ZAPHIRIOU ◽  
S ROBB ◽  
G MENDEZ ◽  
T MURRAYTHOMAS ◽  
S HARDMAN ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Natriuretic Peptide ◽  
The Uk ◽  
Rule Out

A Systematic Review and Meta-analysis : Safety and Efficacy of Mesenchymal stem Cells Therapy for Heart Failure

2020 ◽  
Vol 15 ◽  
Author(s):  
Tiantian Shen ◽  
Lin Xia ◽  
Wenliang Dong ◽  
Jiaxue Wang ◽  
Feng Su ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Safety And Efficacy ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume

Background: Preclinical and clinical evidence suggests that mesenchymal stem cells (MSCs) may be beneficial in treating heart failure (HF). However, the effects of stem cell therapy in patients with heart failure is an ongoing debate and the safety and efficacy of MSCs therapy is not well-known. We conducted a systematic review of clinical trials that evaluated the safety and efficacy of MSCs for HF. This study aimed to assess the safety and efficacy of MSCs therapy compared to the placebo in heart failure patients. Methods: We searched PubMed, Embase, Cochrane library systematically, with no language restrictions. Randomized controlled trials(RCTs) assessing the influence of MSCs treatment function controlled with placebo in heart failure were included in this analysis. We included RCTs with data on safety and efficacy in patients with heart failure after mesenchymal stem cell transplantation. Two investigators independently searched the articles, extracted data, and assessed the quality of the included studies. Pooled data was performed using the fixed-effect model or random-effect model when it appropriate by use of Review Manager 5.3. The Cochrane risk of bias tool was used to assess bias of included studies. The primary outcome was safety assessed by death and rehospitalization and the secondary outcome was efficacy which was assessed by six-minute walk distance and left ventricular ejection fraction (LVEF)，left ventricular end-systolic volume（LVESV），left ventricular end-diastolic volume（LVEDV） and brain natriuretic peptide（BNP） Results: A total of twelve studies were included, involving 823 patients who underwent MSCs or placebo treatment. The overall rate of death showed a trend of reduction of 27% (RR [CI]=0.73 [0.49, 1.09], p=0.12) in the MSCs treatment group. The incidence of rehospitalization was reduced by 47% (RR [CI]=0.53[0.38, 0.75], p=0.0004). The patients in the MSCs treatment group realised an average of 117.01m (MD [95% CI]=117.01m [94.87, 139.14], p<0.00001) improvement in 6MWT.MSCs transplantation significantly improved left ventricular ejection fraction (LVEF) by 5.66 % (MD [95% CI]=5.66 [4.39, 6.92], p<0.00001), decreased left ventricular end-systolic volume (LVESV) by 14.75 ml (MD [95% CI]=-14.75 [-16.18, -12.83], p<0.00001 ) and left ventricular end-diastolic volume (LVEDV) by 5.78 ml (MD [95% CI]=-5.78[-12.00, 0.43], p=0.07 ) ,in the MSCs group , BNP was decreased by 133.51 pg/ml MD [95% CI]= -133.51 [-228.17,-38.85], p=0.54, I2= 0.0%) than did in the placebo group. Conclusions: Our results suggested that mesenchymal stem cells as a regenerative therapeutic approach for heart failure is safe and effective by virtue of their self-renewal potential, vast differentiation capacity and immune modulating properties. Allogenic MSCs have superior therapeutic effects and intracoronary injection is the optimum delivery approach. In the tissue origin, patients who received treatment with umbilical cord MSCs seem more effective than bone marrow MSCs. As to dosage injected, (1-10)*10^8 cells were of better effect.

scholarly journals Natriuretic Peptides and Analytical Barriers

2017 ◽  
Vol 63 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Vlad C Vasile ◽  
Allan S Jaffe
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Myocardial Function ◽  
Specific Assay ◽  
Peptide System ◽  
Cardiovascular Homeostasis ◽  
Natriuretic Peptide System

Abstract BACKGROUND The natriuretic peptide system is an endocrine, autocrine and paracrine system that plays an important role in the maintenance of cardiovascular homeostasis. Biomarkers based on these peptides are important diagnostic and prognostic tools for myocardial function. CONTENT Although natriuretic peptides were discovered more than 2 decades ago, their intricate and complex biology is associated with important questions not yet elucidated. The diversity of circulating forms of natriuretic peptides, the distinct expression of these forms in particular patients, and the heterogeneity of heart failure forms, along with specific assay-related and preanalytic issues, cause assays to be poorly harmonized. SUMMARY This review presents the relevant issues related to the biology of natriuretic peptides and differences between assays with immediate implications for clinical practice.

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