Clinical implications of normal B-type natriuretic peptide levels in patients with severe chronic heart failure

Abstract Background: High plasma B-type natriuretic peptide (BNP) levels in patients with severe chronic heart failure (CHF) often indicate poor ventricular function and poor prognosis. However, in some such patients plasma BNP levels are normal. Objective: To investigate the clinical implications of BNP levels in patients with severe CHF. Methods: Fifty-seven patients with severe CHF were divided into group A (13 normal plasma BNP level) and 44 patients (high plasma BNP levels) group B. Diuretics, angiotensin-converting enzyme inhibitors (or angiotensin II receptor antagonist, e.g., metoprolol) and digitalis were used as conventional treatment. The clinical characteristics of all patients in two groups were analyzed and compared. Results: At the first admission, left ventricular end diastolic diameter in group B was significantly lower than group A (p < 0.05), and the plasma BNP level in group B was significantly higher than group A (p < 0.05). When metoprolol was used, 6 and 5 patients in group A and B could not tolerate the initial dose. In other cases using metoprolol at average maximum tolerance dose of metoprolol 12.5-6.25 and 24.20-11.22 mg/day in group A and B, respectively, there was a significant difference between them (p < 0.05). There were no significant differences in plasma BNP levels between two groups during stable period. The plasma BNP level in group B during acute worsening stage was significantly higher than in the remission stage (962.73-165.00 ng/L vs 876.24-167.70 ng/L, p < 0.05). However, there was no significant difference between group A (74.03-11.18 ng/L) and group B (71.38-11.68 ng/L) (p > 0.05). The mobility of group A was higher than group B (11/12 vs 6/44, p < 0.05). Logistic regression analysis showed that, the plasma BNP level was the independent risk factor for predicting cardiac death (regression coefficient, 3.817; OR, 45.488; 95% CI, 5.322ʺ388.791). Conclusion: In patients with severe CHF, normal plasma BNP level suggests depletion of BNP secretion and further deterioration of cardiac function, indicating a poor prognosis.

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The Plasma Levels of Dehydroepiandrosterone Sulfate Are Decreased in Patients with Chronic Heart Failure in Proportion to the Severity*

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem.85.5.6568 ◽

2000 ◽

Vol 85 (5) ◽

pp. 1834-1840 ◽

Cited By ~ 2

Author(s):

Yasushi Moriyama ◽

Hirofumi Yasue ◽

Michihiro Yoshimura ◽

Yuji Mizuno ◽

Koichi Nishiyama ◽

...

Keyword(s):

Oxidative Stress ◽

Heart Failure ◽

Chronic Heart Failure ◽

Plasma Level ◽

Natriuretic Peptide ◽

Plasma Levels ◽

Thiobarbituric Acid ◽

The Elderly ◽

Dehydroepiandrosterone Sulfate ◽

Significant Difference

Abstract Dehydroepiandrosterone sulfate (DHEAS) is the major secretory steroid of the human adrenal glands. The secretion of DHEAS decreases with aging. The incidence of heart failure also rises in the elderly population. We measured the plasma levels of DHEAS and cortisol in 49 patients with chronic heart failure (CHF) and 32 age-matched controls and assessed its relation to plasma levels of A-type natriuretic peptide and B-type natriuretic peptide, biochemical markers of heart failure. Plasma levels of DHEAS were significantly lower in patients with CHF than in controls, whereas there was no significant difference in plasma levels of cortisol between the two groups. In stepwise regression analysis, the plasma level of DHEAS was significantly and independently correlated with age (β = −0.451; P < 0.0001) and the plasma level of B-type natriuretic peptide (β = −0.338; P < 0.001), and the plasma cortisol/DHEAS ratio was significantly and independently correlated with the plasma levels of A-type natriuretic peptide (β = 0.598; P < 0.0001) and thiobarbituric acid-reactive substances (a marker of oxidative stress;β = 0.252; P < 0. 01) and age (β = 0.171; P < 0.05). These results indicate that the plasma levels of DHEAS are decreased in patients with CHF in proportion to its severity and that oxidative stress is associated with decreased levels of DHEAS in patients with CHF.

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Shexiang Baoxin Pills as an Adjuvant Treatment for Chronic Heart Failure: A System Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2018/6949348 ◽

2018 ◽

Vol 2018 ◽

pp. 1-13 ◽

Cited By ~ 6

Author(s):

Taiwei Dong ◽

Jian Wang ◽

Xiao Ma ◽

Rong Ma ◽

Jianxia Wen ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Natriuretic Peptide ◽

Adjuvant Treatment ◽

Conventional Treatment ◽

Meta Analysis ◽

Walking Distance ◽

Cochrane Library ◽

Efficacy Rate ◽

Significant Difference

Background. Shexiang Baoxin pills (SXBXP), as a Traditional Chinese Medicine, are widely used for chronic heart failure in China. It is essential to systematically assess the efficacy and safety of SXBXP as an adjuvant treatment for chronic heart failure. Methods. Seven English and Chinese electronic databases (PubMed, Embase, Cochrane Library, CBM, Wanfang, VMIS, and CNKI) were searched from inception to July 2017. The Cochrane Risk of Bias tool was used to evaluate the methodological quality of eligible studies. Meta-analysis was performed by Review Manager 5.3. Results. A total of 27 RCTs with 2637 participants were included in this review. Compared to conventional treatment, SXBXP combined with conventional treatment showed potent efficacy when it came to the total efficacy rate (OR, 3.88; 95% CI, 2.87, 5.26; P<0.00001), B-type natriuretic peptide (BNP) (MD = −66.95; 95% CI, −108.57, −25.34; P=0.002), N-terminal pro-brain natriuretic peptide (NT-ProBNP) (MD = −0.15; 95% CI, −0.21, −0.09; P<0.00001), six-minute walking distance (6-MWD) (MD = 38.57; 95% CI, 28.47, 48.67; P<0.00001), cardiac output (CO) (MD = 0.84; 95% CI, 0.68, 0.99; P<0.00001), and Stroke Volume (SV) (MD = 7.43; 95% CI, 4.42, 10.44, P<0.00001). The pooled subgroup analysis indicated that there was a significant difference between SXBXP plus conventional treatment and conventional treatment alone in short term course (OR = 3.51; 95% CI, 2.28, 5.40; P<0.00001), in middle period of treatment (OR = 5.01; 95% CI, 2.61, 9.60; P<0.00001), and in long-term course (OR = 3.77; 95% CI, 2.13, 6.67; P<0.00001). No serious adverse events or reactions were mentioned in these RCTs. Conclusions. As an adjuvant drug, this study suggested that SXBXP provide an obvious efficacy for the treatment of CHF. However, due to small samples and generally low quality studies being applied in this study, more rigorous and well-designed RCTs are needed to confirm these findings.

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Abstract 15258: Higer Unipolar Voltage at Cell Injection Sites Correlates With Better Outcomes After Transendocardial Cd34 + Cell Transplantation in Patients With Chronic Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.15258 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Gregor Poglajen ◽

Neža Žorž ◽

Gregor Zemljic ◽

Sabina Frljak ◽

Andraz Cerar ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Cell Therapy ◽

Clinical Response ◽

Cell Injection ◽

Local Linear ◽

Group A ◽

Favorable Clinical Response ◽

Group B ◽

The Impact

Introduction: The evidence supporting the impact of electroanatomic guidance in defining the targets for transendocardial cell injections in chronic heart failure (CHF) remains inconclusive. Hypothesis: We evaluated a correlation between electroanatomic properties of the myocardium at the cell injection sites and clinical response to CD34 + cell therapy in CHF patients. Methods: We enrolled 131 consecutive patients with CHF and LVEF<40% undergoing CD34 + cell therapy at a single study site. All patients received bone-marrow stimulation with filgrastim for 5 days; CD34 + cells were collected by apheresis and injected transendocardialy (80x10 6 cells per patient). Target injection sites were defined by electroanatomical mapping as myocardial areas with unipolar voltage >8.3mV and local linear shortening <6%. Favorable clinical response was defined as an increase in LVEF≥5% between baseline and 6 months follow-up. Results: Of 131 patients 69 (53%) displayed a favorable clinical response (Group A) and 62 (47%) patients failed to respond to cell therapy (Group B). At baseline, the groups did not differ in gender (male: 89% in Group A vs. 84% in Group B, P=0.45), age (53±12 years vs. 55±11 years, P=0.25), CHF etiology (ischemic: 22% vs. 32%, P=0.17), LVEF (29±6% vs. 32±7%, P=0.06), or LVEDD (6.3±1.2 cm vs. 6.7±1.0 cm, P=0.10). Patients in Group A had lower baseline creatinine (81±20 μmol/L vs. 92±24 μmol/L in Group B, P=0.005), and lower levels of NT-proBNP (931±1078 pg/mL vs. 2716±2716, P=0.001). The number of cell injections in Groups A and B was comparable (17.3±2.6 injections vs. 17.6±3.5 injections, P=0.60). When analyzing the electroanatomical properties at cell injection sites, we found significantly higher unipolar voltage in Group A (11.2±3.7 mV vs. 9.5±2.6 mV in Group B, P=0.005). However, we found no differences in injection site local linear shortening between the groups (2.7±3.9% in Group A vs. 3.4±3.4 in group B, P=0.56). Conclusions: In CHF patients, higher unipolar voltage at the cell injection sites appears to correlate with better clinical response to transendocardial CD34 + cell therapy. Thus, cell injections guided by measurements of myocardial viability may offer an advantage over blind cell injection strategies in this patient population.

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Serum uric acid levels in patients of acute myocardial infarction

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20195616 ◽

2019 ◽

Vol 7 (1) ◽

pp. 51

Author(s):

Hardeep Singh Deep ◽

Jasmine Kaur ◽

Gaurav Chopra ◽

Jaskiran Kaur ◽

Jasleen Kaur ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Congestive Heart Failure ◽

Uric Acid ◽

Serum Uric Acid ◽

Control Group ◽

Significant Difference ◽

Group A ◽

Group B

Background: Following Myocardial Infarction some proteins and enzymes, CPK-MB/ Troponin-I, T, are released into the blood from the necrotic heart muscle. Serum Uric Acid (SUA) may be a risk factor and negative prognostic marker for cardiovascular diseases. Aim of the study was to study serum uric acid levels in patients of acute Myocardial infarction with congestive heart failure, its relation with stages of congestive heart failure as per Killip classification and the role of serum uric acid levels as a marker of mortality.Methods: The case control study was conducted on 120 patients divided into two groups. Group A included 60 patients of acute Myocardial infarction. Group A was further divided into two categories. One includes 30 patients of with congestive heart failure and another includes 30 patients without congestive heart failure. Group B consists of 60 control patients. Serum uric acid levels were measured in Group A on 1st, 3rd and 7th day of hospital admission and in Group B on 1st day.Results: The study showed females have higher degree of hyperuricemia than males. SUA was significantly higher in patients of acute myocardial infarction than control group patients. SUA were also higher in patients with history of IHD, in patients with BNP >100 and it correlates with Killip class and mortality rates. Patients of acute myocardial infarction with diabetes mellitus had higher degree of hyperuricemia than nondiabetic and control group. No significant difference in SUA levels were observed with regard to age, alcohol intake, lipid profile, ejection fraction and hypertension.Conclusions: In acute myocardial infarction, patients with hyperuricemia had higher mortality and may be considered as poor prognostic biomarker.

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