scholarly journals Combined Assessment of D-Dimer with the Get with the Guidelines—Heart Failure Risk Score and N-Terminal Pro-B-Type Natriuretic Peptide in Patients with Acute Decompensated Heart Failure with Preserved and Reduced Ejection Fraction

2021 ◽  
Vol 10 (16) ◽  
pp. 3564
Author(s):  
Hiroyuki Naruse ◽  
Junnichi Ishii ◽  
Hiroshi Takahashi ◽  
Fumihiko Kitagawa ◽  
Eirin Sakaguchi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Natriuretic Peptide ◽  
Risk Score ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Baseline Model ◽  
Ventricular Ejection Fraction ◽  
Get With The Guidelines ◽  
D Dimer

The prognostic role of D-dimer in different types of heart failure (HF) is poorly understood. We investigated the prognostic value of D-dimer on admission, both independently and in combination with the Get With The Guidelines—Heart Failure (GWTG-HF) risk score and N-terminal pro-B-type natriuretic peptide (NT-proBNP), in patients with preserved left ventricular ejection fraction (LVEF) and acute decompensated HF (HFpEF) or reduced LVEF (HFrEF). Baseline D-dimer levels were measured on admission in 1670 patients (mean age: 75 years) who were hospitalized for worsening HF. Of those patients, 586 (35%) were categorized as HFpEF (LVEF ≥ 50%) and 1084 as HFrEF (LVEF < 50%). During the 12-month follow-up period after admission, 360 patients died. Elevated levels (at least the highest tertile value) of D-dimer, GWTG-HF risk score, and NT-proBNP were all independently associated with mortality in all HFpEF and HFrEF patients (all p < 0.05). Adding D-dimer to a baseline model with a GWTG-HF risk score and NT-proBNP improved the net reclassification and integrated discrimination improvement for mortality greater than the baseline model alone in all populations (all p < 0.001). The number of elevations in D-dimer, GWTG-HF risk score, and NT-proBNP were independently associated with a higher risk of mortality in all study populations (HFpEF and HFrEF patients; all p < 0.001). The combination of D-dimer, which is independently predictive of mortality, with the GWTG-HF risk score and NT-proBNP could improve early prediction of 12-month mortality in patients with acute decompensated HF, regardless of the HF phenotype.

scholarly journals “Get with the Guidelines Heart Failure Risk Score” for mortality prediction in patients undergoing MitraClip

2021 ◽  
Author(s):  
Christos Iliadis ◽  
Maximilian Spieker ◽  
Refik Kavsur ◽  
Clemens Metze ◽  
Martin Hellmich ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Score ◽  
Goodness Of Fit ◽  
Left Ventricular ◽  
Risk Scores ◽  
Left Ventricular Ejection ◽  
Goodness Of Fit Test ◽  
Ventricular Ejection Fraction ◽  
Failure Risk ◽  
Get With The Guidelines

Abstract Background Reliable risk scores in patients undergoing transcatheter edge-to-edge mitral valve repair (TMVR) are lacking. Heart failure is common in these patients, and risk scores derived from heart failure populations might help stratify TMVR patients. Methods Consecutive patients from three Heart Centers undergoing TMVR were enrolled to investigate the association of the “Get with the Guidelines Heart Failure Risk Score” (comprising the variables systolic blood pressure, urea nitrogen, blood sodium, age, heart rate, race, history of chronic obstructive lung disease) with all-cause mortality. Results Among 815 patients with available data 177 patients died during a median follow-up time of 365 days. Estimated 1-year mortality by quartiles of the score (0–37; 38–42, 43–46 and more than 46 points) was 6%, 10%, 23% and 30%, respectively (p < 0.001), with good concordance between observed and predicted mortality rates (goodness of fit test p = 0.46). Every increase of one score point was associated with a 9% increase in the hazard of mortality (95% CI 1.06–1.11%, p < 0.001). The score was associated with long-term mortality independently of left ventricular ejection fraction, NYHA class and NTproBNP, and was equally predictive in primary and secondary mitral regurgitation. Conclusion The “Get with the Guidelines Heart Failure Risk Score” showed a strong association with mortality in patients undergoing TMVR with additive information beyond traditional risk factors. Given the routinely available variables included in this score, application is easy and broadly possible. Graphic abstract

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 How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

2019 ◽  
Vol 40 (40) ◽  
pp. 3297-3317 ◽  
Author(s):  
Burkert Pieske ◽  
Carsten Tschöpe ◽  
Rudolf A de Boer ◽  
Alan G Fraser ◽  
Stefan D Anker ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Natriuretic Peptide ◽  
Diagnostic Algorithm ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction

Abstract Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the ‘HFA–PEFF diagnostic algorithm’. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for HF symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e′), left ventricular (LV) filling pressure estimated using E/e′, left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2–4 points) implies diagnostic uncertainty, in which case Step 3 (F1: Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2: Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.

scholarly journals CORRELATION BETWEEN NT-PROBNP AND LEFT VENTRICULAR EJECTION FRACTION BY ECHOCARDIOGRAPHY IN HEART FAILURE PATIENTS

2018 ◽  
Vol 23 (2) ◽  
pp. 114
Author(s):  
Mutiara DS ◽  
Leonita Anniwati ◽  
M. Aminuddin
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Natriuretic Peptide ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Heart Failure Patients ◽  
Quasi Experimental

Petanda biologis NH2-terminal fragment of proBrain Natriuretic Peptide (NT-proBNP) berguna untuk diagnosis dini, menyingkirkangejala klinis yang berasal dari luar jantung serta pemantauan pengobatan dan meramalkan perjalanan penyakit pasien gagal jantung.Pemeriksaan NT-proBNP dapat dilakukan secara otomatis, sehingga hasil tidak bersifat subjektif. Pemeriksaan ekokardiografi merupakanpemeriksaan penunjang yang telah umum digunakan untuk mendiagnosis gagal jantung. Namun, pemeriksaan ekokardiografi tidakselalu tersedia di seluruh rumah sakit, khususnya rumah sakit di daerah, serta memerlukan tenaga ahli untuk melakukan pemeriksaandan hasil pemeriksaan bersifat subjektif. Salah satu tolok ukur yang dinilai pada pemeriksaan ekokardiografi adalah fraksi ejeksiventrikel kiri. Penelitian ini bertujuan untuk mengetahui kenasaban antara kadar NT-proBNP dengan fraksi ejeksi ventrikel kiri yangdiperoleh dari pemeriksaan ekokardiografi. Penelitian bersifat quasi experimental dengan pendekatan pretest and posttest only withoutcontrol. Sampel penelitian berjumlah 41 orang, dikumpulkan selama bulan Februari–April 2015 dari Ruang Perawatan Jantung RSUDDr. Soetomo Surabaya. Pemeriksaan kadar NT-proBNP menggunakan metode chemiluminescent (Immulite 1000) dengan prinsip solidphasetwo site chemiluminescent immunometric assay. Hasil dianalisis secara statistik menggunakan uji kenasaban Spearman’s, ujit 2 sampel berpasangan, Kruskal Wallis dan Mann Whitney. Rentang kadar NT-proBNP sebelum dan sesudah pemberian pengobatandi pasien gagal jantung masing-masing antara 1.296–34.374 pg/mL dengan rerata 10.422,49 pg/mL (Simpang Baku (SB) 8.608,05)dan 997–34.401 pg/mL dengan rerata 8.899,41 pg/mL (SB 8.489,46). Rentang persentase fraksi ejeksi ventrikel kiri sebelum dansesudah pemberian pengobatan di pasien gagal jantung masing-masing antara 20–62% dengan rerata 35,61% (SB 10,00) dan 22–71%dengan rerata 41,49% (SB 10,96). Didapatkan perbedaan bermakna rerata kadar NT-proBNP serta persentase fraksi ejeksi ventrikel kirisebelum dan sesudah pemberian pengobatan di pasien gagal jantung dengan setiap nilai p=0,001. Didapatkan kenasaban negatif yangbermakna antara kadar NT-proBNP dan fraksi ejeksi ventrikel kiri di pasien gagal jantung sebelum dan sesudah pemberian pengobatandengan masing-masing nilai p=0,001, r=-0,81 dan nilai p=0,001, r=-0,80. Didapatkan kenasaban negatif yang bermakna antarakadar NT-proBNP dengan fraksi ejeksi ventrikel kiri di pasien gagal jantung sebelum dan sesudah pemberian pengobatan. Berdasarkanhal tersebut maka pemeriksaan petanda biologis NT-proBNP dapat diusulkan untuk digunakan sebagai tolok ukur pilihan penggantiekokardiografi untuk gagal jantung.

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