scholarly journals Extrém magas B típusú natriureticus prohormon prognosztikai szerepe a szívelégtelenség miatt kezelt betegek kórházi halálozására

2017 ◽  
Vol 158 (20) ◽  
pp. 779-782
Author(s):  
Béla Bózsik ◽  
Erzsébet Nagy ◽  
Miklós Somlói ◽  
János Tomcsányi
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Prognostic Value ◽  
Response To Therapy ◽  
Cardiology Department ◽  
The Difference ◽  
One Year

Abstract: Introduction: Patients hospitalized for heart failure have a very high in-hospital as well as one-year mortality. Natriuretic peptides play both a diagnostic and a prognostic role in this disease. Changes of natriuretic peptide levels in response to therapy are a well-known prognostic marker. Regarding in-hospital mortality, however, little is known about the prognostic value of extremely high levels of natriuretic peptides measured on admission. Aim: To decide whether extremely high levels of B-type natriuretic peptide have a prognostic value with regard to in-hospital mortality. Method: NT-proBNP levels on admission and in-hospital mortality were extracted retrospectively from the data of patients treated with heart failure in the cardiology department of the Hospital of St. John of God in Budapest. We separately analyzed the data of patients hospitalized for heart failure in 2015 with extremely high initial NT-proBNP levels. The cut-off value in this regard was 10 000 ng/l. We also analyzed the comorbidities of these patients. Results: The median NT-proBNP level of those patients who survived beyond the index hospital stay in the last 10 years was 4842 ng/l, whereas the median NT-proBNP level of those 182 patients who died during their hospital stay was 10 688 ng/l (p<0.001). In the year 2015, we treated 118 patients with an NT-proBNP level above 10 000 ng/l. Thirteen of these patients died, which means that their in-hospital mortality exceeded 10%. In comparison, the in-hospital mortality of all heart failure patients was 5.8%. The difference of median NT-proBNP levels of surviving versus deceased patients in this group with extremely high NT-proBNP levels was no longer significant (17 080 ng/l vs. 19 152 ng/l). Conclusions: Patients with an NT-proBNP level of >10 000 ng/l on admission have a significantly higher in-hospital mortality. The difference of NT-proBNP levels of surviving versus deceased patients in the group with admission NT-proBNP levels >10 000 ng/l is no longer significant. We could not identify any etiological factors that would explain these extremely high NT-proBNP levels or the excess in-hospital mortality. Orv Hetil. 2017; 158(20): 779–782.

Atrial natriuretic peptides in heart failure: pathophysiological significance, diagnostic and prognostic value

2011 ◽  
Vol 89 (8) ◽  
pp. 587-591 ◽  
Author(s):  
Nina Ghosh ◽  
Haissam Haddad
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Prognostic Value ◽  
Diagnostic Value ◽  
Grey Zone ◽  
Long Term Effects ◽  
Diagnosis And Prognosis ◽  
Diagnostic And Prognostic Value ◽  
Atrial Natriuretic

Neurohormonal activation in patients with heart failure is dominated by the deleterious long-term effects of activation of the sympathetic nervous system and the renin–angiotensin–aldosterone system. The natriuretic peptides, including brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP), are also upregulated in heart failure, and partially counteract these deleterious effects by promoting vasodilation, natriuresis, and diuresis. Although BNP has been established as an important biomarker in the diagnosis and prognosis of heart failure, growing evidence suggests that measurement of plasma ANP, specifically its metabolite mid-regional pro-ANP, has similar diagnostic and prognostic value. Furthermore, its measurement may provide incremental diagnostic value when BNP levels fall into “grey zone” levels and may be a more potent prognostic marker of mortality.

scholarly journals Correlates and short-term prognostic value of plasma n-terminal pro-brain natriuretic peptide levels among heart failure patients: A prospective cohort study

2021 ◽  
Author(s):  
Mark Mayala ◽  
Khuzeima Khanbhai ◽  
Ponsian Peter ◽  
Pilly Chillo
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Brain Natriuretic Peptide ◽  
Hospital Stay ◽  
Natriuretic Peptide ◽  
Prospective Cohort ◽  
Prognostic Value ◽  
Functional Class ◽  
Short Term ◽  
Nyha Functional Class

Abstract BackgroundStudies conducted in developed countries have found measurements of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) to be important in evaluating heart failure (HF) prognosis, however this has not yet been studied in sub-Saharan Africa. The aim of this study was to determine clinical correlates and short-term prognostic value of plasma NT-proBNP levels among HF patients.MethodologyThis was a hospital-based prospective cohort study conducted at Jakaya Kikwete Cardiac Institute, Tanzania from June to December 2020. Patients were consecutively enrolled when they fulfilled the inclusion criteria. Clinical details and NT-proBNP levels were measured at baseline and at 30-day follow-up. Pearson's chi square test was used to associate New York Heart Association (NYHA) functional class and NT-proBNP levels, while Spearman’s correlation coefficient was used to correlate between left ventricular ejection fraction (LVEF) and NT-proBNP levels. Receiver Operating Characteristic (ROC) curves were drawn to determine the best prognostic cut off points of NT-proBNP levels for the different clinical outcomes. A P-value of <0.05 was considered statically significant.Results155 HF patients were enrolled. Their mean±SD age was 48±16 years, 52.3% were male and their mean ±SD LVEF was 37.3±10.7%. At baseline, the median (IQR) NT-proBNP levels was 7654pg/ml (2289, 16000), and the levels dropped to 3383pg/ml (731, 9785) after 1 month. Baseline plasma levels of NT-proBNP increased as the NYHA functional class worsened, (P = 0.018), and with decreasing LVEF (r = -0.65, p<0.05). The ROC curve identified an overall cut-off point for poor prognosis at 18000pg/ml with 54.4% sensitivity and 93.7% specificity (area under the curve (AUC): 0.8). The NT-proBNP cut-off point for mortality was 24500 pg/ml with 100% sensitivity and specificity of 92.54% (AUC: 0.958). The ROC analysis also identified levels of NT-proBNP of ≥7899pg/ml to predict re-hospitalization, with 76% sensitivity and 60% specificity (AUC: 0.68), while levels ≥18762.1 pg/ml predicted long hospital stay with a sensitivity of 100% and specificity of 85.62% (AUC: 0.939).ConclusionThese results demonstrate that NT-proBNP is a powerful measure to predict readmission, mortality and long hospital stay in HF patients and can facilitate discussions with patient prognosis, decisions regarding interventions, and continuity of care.

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.

Prognostic value of N-terminal pro-B-type natriuretic peptide, cytokines and sCD40L in patients with acute heart failure

2006 ◽  
Vol 40 (6) ◽  
pp. 953
Author(s):  
Radek Pudil ◽  
Milos Tichy ◽  
Ctirad Andrys ◽  
Marcela Drahosova ◽  
Vaclav Blaha ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Prognostic Value

Abstract 2793: Comparison of Midregional Pro-atrial Natriuretic Peptide, B-type Natriuretic Peptide, and Amino-terminal Pro-B-type Natriuretic Peptide in Patients with Chronic Heart Failure: Influencing Factors, Detection of Left Ventricular Systolic Dysfunction, and Prediction of Death

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Deddo Moertl ◽  
Martin Huelsmann ◽  
Joachim Struck ◽  
Andreas Gleiss ◽  
Alexandra Hammer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Atrial Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Influencing Factors ◽  
Natriuretic Peptides ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction

Background: Although natriuretic peptides are increasingly used for the management of chronic heart failure (CHF), there are sparse comparative data. Therefore, we compared the importance of influencing factors, the ability to detect left ventricular systolic dysfunction, and the prognostic power of midregional pro-atrial natriuretic peptide (MR-proANP), B-type natriuretic peptide (BNP), and aminoterminal pro-B-type natriuretic peptide (NT-proBNP) in patients with chronic heart failure. Methods and Results: MR-proANP, using a new assay directed at the midregion of aminoterminal-proANP, was compared with BNP and NT-proBNP, using conventional assays, in 797 patients with CHF. All three natriuretic peptides were independently influenced by left ventricular ejection fraction (LVEF), glomerular filtration rate (GFR), and the presence of ankle edema. Area under receiver-operator characteristic curves for detection of an LVEF <40% were similar between MR-proANP (0.799 [0.753– 0.844]) and BNP (0.803 [0.757– 0.849]), and NT-proBNP (0.730 [0.681– 0.778]. During a median observation time of 68 months, 492 patients died. In multiple Cox regression analysis each natriuretic peptide was the strongest prognostic parameter among various clinical variables, but proportion of explained variation showed that NT-proANP was a significantly stronger predictor of death than NT-proBNP and BNP (Figure ). Conclusions: Despite similarities in influencing factors and detection of reduced LVEF, MR-proANP outperformed BNP and NT-proBNP in the prediction of death. A new assay technology and the high biological stability of MR-proANP are potential explanations for these findings.

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