Biomarkers ; blood ; Child ; Heart Failure ; blood ; diagnosis ; physiopathology ; Humans ; Natriuretic Peptide, Brain ; blood

OBJECTIVETo observe the prognostic value of admission B-type natriuretic peptide (BNP) on outcome for patients with congestive heart failure (CHF).

METHODSBlood BNP levels, routine echocardiography and tissue Doppler image were obtained in 162 CHF patients [95 male, mean age: (71.8±3.7) years] at admission. Patients were divided into high BNP (BNP>1500 ng/L, n=104) and low BNP (BNP≤1500 ng/L, n=58) groups. All patients were followed up for 2 years and clinical characteristics, echocardiography including Doppler image and cardiovascular events results were analyzed. Data were also compared between patients with (n=48) or without (n=107) cardiovascular events.

RESULTSLeft ventricular ejection fractions (LVEF) was significantly lower [(40.9±5.6)% vs. (44.0±5.9)%, P<0.01] while the total cardiovascular events rate (49.1% vs. 21.0%, P<0.01) and cardiac mortality rate (25.5% vs. 9.0%, P<0.01) were significantly higher in high BNP group than in low BNP group. BNP level at admission in event group was significantly higher than in event-free group [(2875.4±325.7) ng/L vs. (1136.9±298.6) ng/L, P<0.000]. BNP level was positively related to Tei-index (r=0.793, P<0.001) and negatively correlated with LVEF (r=-0.57, P<0.001). Multiple logistic regression analysis demonstrated that BNP, LVEF, Tei-index and β-blocker use were independent risk factors for cardiovascular events. The area under the ROC curve for predicting cardiovascular death within 2 years in event group by BNP was 0.795 (95%CI 0.693-0.935, sensitivity: 72.31% and specificity: 84.62%, cut-off BNP value: 1910 ng/L). The event risk was 2.17 times higher in CHF patients with admission BNP>1910 ng/L compared CHF patients with admission BNP≤1910 ng/L (95%CI: 1.852-2.954, P=0.000).

CONCLUSIONAdmission BNP level, LVEF, Tei-index and β-blocker use are independent risk factors for cardiovascular events in patients with CHF. Patients with higher admission BNP level (>1910 ng/L) is linked with worse prognosis in this patient cohort.

Aged ; Female ; Heart Failure ; blood ; diagnosis ; Humans ; Male ; Natriuretic Peptide, Brain ; blood ; Prognosis ; Survival Rate

OBJECTIVETo investigate the change in the serum level of follistatin-like protein 1 (FSTL1) in children with chronic heart failure and its correlation with left ventricular remodeling.

METHODSA total of 45 children with chronic heart failure (CHF) between May 2014 and May 2015 were selected as the CHF group, among whom 21 had endocardial fibroelastosis (EFE) and 24 had dilated cardiomyopathy (DCM); another 30 healthy children were selected as the control group. Enzyme-linked immunosorbent assay was applied to measure the serum level of FSTL1. Radioimmunoassay was applied to measure N-terminal pro-brain natriuretic peptide, and echocardiography was applied to measure the indicators of left ventricular remodeling. The correlation between the serum level of FSTL1 and left ventricular remodeling was analyzed by Pearson correlation and Spearman′s rank correlation analysis.

RESULTSBefore treatment, the CHF group had a significantly higher serum level of FSTL1 than the control group (P<0.05), which gradually increased with aggravation of CHF (P<0.05). The serum level of FSTL1 showed no significant difference between the EFE and DCM groups (P=0.176). Serum level of FSTL1 was positively correlated with left ventricular end-diastolic diameter (r=0.485, P=0.001), left ventricular mass (r=0.322, P=0.031), left ventricular mass index (r=0.353, P=0.017), and N-terminal pro-brain natriuretic peptide (r=0.562 P<0.001), and was negatively correlated with left ventricular ejection fraction (r=-0.436, P=0.003) and left ventricular minor axis decurtation rate (r=-0.436, P=0.003).

CONCLUSIONSFSTL1 might take part in the left ventricular remodeling in children with CHF, and the serum level of FSTL1 can be used as an objective index for clinical diagnosis and severity assessment of CHF in children.

Child ; Child, Preschool ; Female ; Follistatin-Related Proteins ; blood ; Heart Failure ; blood ; diagnosis ; Humans ; Infant ; Male

No abstract available.
*Asian Continental Ancestry Group ; Female ; Heart Failure/*diagnosis ; *Hospitalization ; Humans ; Hyponatremia/*diagnosis ; Male ; Sodium/*blood

OBJECTIVETo study the values of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in the evaluation of cardiac function in children with congenital heart disease (CHD).

METHODSSeventy-one children with CHD were classified to two groups: congestive heart failure (CHF) (n=23 ) and non-CHF (n=48). Thirty-five age-matched normal children were used as the control group. Plasma BNP content was measured using a microparticle enzyme immunoassay (MEIA) on the AxSYM. Plasma NT-proBNP content was measured using an automated electrochemiluminescence immunoassay on a Roche Modular Analytics E170 analyzer. Echocardiographic parameters, including left ventricular end diastolic dimension index (LVEDDI) and left ventricular ejection fraction (LVEF), were measured.

RESULTSPlasma BNP and NT-proBNP contents in the CHF group were significantly higher than those in the non-CHF group (P<0.01). The non-CHF group had higher plasma BNP and NT-proBNP contents than the control group (P<0.01). LogBNP and LogNT-proBNP values were negatively correlated with the LVEF in the CHF group (r=-0.64, r=-0.67 respectively, P<0.01), and they were positively correlated with the LVEDDI (r=0.58, r=0.76 respectively, P<0.01). In the non-CHF group, LogBNP and LogNT-proBNP values were not correlated with the LVEF, but a positive correlation was found between the LogNT-proBNP value and the LVEDDI (r=0.35, P<0.05). Using plasma BNP content > or =149.8 pg/mL and NT-proBNP content > or =820.1 pg/mL as cut-off values for diagnosing CHF respectively, the sensitivities were 87.0 % and 91.3% respectively, the specificities were 91.7% and 97.9% respectively, and the areas under the ROC curves were 0.935 and 0.987 respectively.

CONCLUSIONSBoth BNP and NT-proBNP can be useful in assessment of cardiac function and diagnosis of CHF in children with CHD. NT-proBNP appears to be more sensitive and specific in the diagnosis of CHF than BNP.

Child ; Child, Preschool ; Diastole ; Female ; Heart ; physiopathology ; Heart Defects, Congenital ; blood ; physiopathology ; Heart Failure ; diagnosis ; Humans ; Infant ; Male ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Ventricular Function, Left

Hypertension affects the majority of patients with chronic kidney disease (CKD) and increases the risk of cardiovascular disease, end-stage renal disease and mortality. Previously, many hypertension guidelines have suggested blood pressure targets in patients with CKD. Recently, the American College of Cardiology/American Heart Association 2017 Guideline for Hypertension suggests a new definition for hypertension and therapeutic targets, which were equally applicated to patients with CKD. These changes reflect the results of the Systolic Blood Pressure Intervention Trial (SPRINT) study, but the renal outcome of intensive blood pressure control was not good. Furthermore, the majority of hypertension guidelines including those of the Korean Society of Hypertension and the European Society of Hypertension have retained the traditional definition. Herein, we intend to analyze in detail the effect of intensive blood pressure control on kidney through the post-hoc analyses of the SPRINT study.
Blood Pressure ; Cardiovascular Diseases ; Diagnosis ; Heart ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Mortality ; Renal Insufficiency, Chronic

OBJECTIVEThe value of plasma brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) can reflect cardiac function and therefore can be used for diagnosing congestive heart failure (CHF) and evaluating cardiac function. There are few reports, however, on the value of BNP and NT-proBNP in pediatric cases of congenital heart defect. The aim of this study was to assess the value of plasma NT-proBNP in the diagnosis of CHF and evaluation of cardiac function in pediatric patients with ventricular septal defect (VSD).

METHODSFifty-one patients with VSD aged from 2 months to 2 years old (mean 7.9 months) were enrolled. According to the modified Ross Score, the patients were divided into three groups, no CHF group (20 patients), mild CHF group (18 patients) and moderate to severe CHF group (13 patients). Fifteen age-matched normal children were used as controls. Plasma NT-proBNP was measured using enzyme immunoassay. All patients had complete echocardiographic study, including measurement of left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic wall stress (LVSEWS), heart rate corrected mean velocity of circumferential fiber shortening (mVcFc), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and contractility index (Con). The correlation between plasma NT-proBNP level and modified Ross Score and echocardiographic cardiac functional indexes was determined. The sensitivity, specificity and ROC curve of plasma NT-proBNP for diagnosing CHF was studied.

RESULTSPlasma NT-proBNP was positively correlated with modified Ross Score (r = 0.75, P < 0.01). Plasma NT-proBNP concentration in moderate to severe CHF group (2061 +/- 908) fmol/ml was significantly higher than that of mild CHF group (810 +/- 335) fmol/ml, and Plasma NT-proBNP concentration in mild CHF group was higher than that in no CHF group (309 +/- 68) fmol/ml. 97.14% of normal controls and subjects in no CHF group had their plasma NT-proBNP below 400 fmol/ml. 83.3% of children in mild CHF group had their plasma NT-proBNP between (400-1400) fmol/ml while in moderate and severe CHF group 84.6% of children had their plasma NT-proBNP beyond 1400 fmol/ml. Plasma NT-proBNP was also positively correlated with LVEDVI and LVSEWS. There was no correlation among mVcFc, LVEF, LVFS, Con and plasma NT-proBNP concentration. Using plasma NT-proBNP concentration > or = 400 fmol/ml as cut-point for diagnosing CHF, the sensitivity was 89.3%, the specificity was 91.2%, and the area under the ROC curve was 0.944.

CONCLUSIONSPlasma NT-proBNP level could be used to assess cardiac function and diagnose CHF in pediatric patients with VSD.

Echocardiography ; Female ; Heart Failure ; blood ; Heart Septal Defects, Ventricular ; blood ; diagnosis ; Humans ; Infant ; Male ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Ventricular Function, Left

OBJECTIVETo explore the correlation between plasma BNP level and left ventricular dysfunction parameters in patients with acute myocardial infarction (AMI).

METHODSPlasma BNP level was determined in 230 consecutive inpatients with AMI and 111 normal controls. Patients were grouped according Killip grades, LVEF and LVEDd, respectively. BNP was transformed into lnBNP for the normal distribution. The receiver operator characteristic curve (ROC curve) was drawn to determine the best threshold and criteria for diagnosing heart failure.

RESULTSAfter AMI, lnBNP levels increased significantly in proportion with increasing Killip grades (I-III), and decreasing LVEF (all P < 0.05). lnBNP level was significantly higher in LVEDd > 55 mm group than in the LVEDd < 55 mm group (P < 0.01). lnBNP, LVEDd and LVEF all linearly correlated with Killip grades (P < 0.05) and the best correlation was shown between lnBNP and Killip grades (r = 0.53, P < 0.05). lnBNP also positively correlated with LVEDd (r = 0.17, P < 0.05) and negatively correlated with LVEF (r = -0.41, P < 0.01). Among the parameters, lnBNP level presented the largest AUC in their ROC curves (P < 0.01) for diagnosing decompensated heart failure and cardiogenic shock. The sensitivity, specifiticity and accuracy rates for diagnosing decompensated heart failure were 84.9%, 45.0% and 70.0% respectively by lnBNP at the cut point of 140 ng/L. The sensitivity, negative predicting value and accuracy rate for diagnosing cardiac shock were 82.8%, 66.7% and 67.4% respectively by BNP at the cut point of 400 ng/L.

CONCLUSIONlnBNP level in hospitalized patients with AMI was positively correlated with Killip grades and LVEDd, negatively correlated with LVEF and could serve as a parameter for diagnosing the decompensated heart failure and excluding the cardiac shock.

Anterior Wall Myocardial Infarction ; Heart Failure ; diagnosis ; Humans ; Myocardial Infarction ; diagnosis ; Natriuretic Peptide, Brain ; blood ; Ventricular Dysfunction, Left ; diagnosis

BACKGROUND AND OBJECTIVES: Although Doppler echocardiography has been used to identify left ventricular (LV) diastolic dysfunction, its limitations suggest there is a need for new biomarkers to measure the diastolic dysfunction. Because the B-type natriuretic peptide (BNP) levels correlate with the LV diastolic pressure, we hypothesized that the BNP would be useful for diagnosing and monitoring the patients with diastolic heart failure. SUBJECTS AND METHODS: We prospectively studied a total of 69 consecutive patients (mean age: 68+/-12 yrs, 31 men and 38 women) who presented to the emergency room with suspected dyspnea of a cardiac origin from November 2003 to May 2004. BNP sampling and Doppler echocardiography were performed for all the study patients. We diagnosed the systolic heart failure (SHF) and diastolic heart failure (DHF) on the conditions that both the clinical and echocardiographic criteria for systolic and diastolic dysfunction were fulfilled. From June 2004 to May 2005, we also performed clinical examinations, measurement of the tissue Doppler derived E/E' and the BNP level at baseline and at 1 year after pharmacologic treatment for 42 consecutive patients who were diagnosed with DHF in the ER and the outpatient clinic. RESULTS: We diagnosed SHF in 37 patients, DHF in 19 patients and we excluded HF in 13 patients (the control group). The mean BNP levels of the SHF and DHF groups were 716+/-532 pg/mL and 390+/-446 pg/mL, respectively, and these values were significantly higher than that of the control group (13+/-14 pg/mL, p<0.01). The area under the receiver-operating characteristic (ROC) curve for BNP to diagnose DHF was 0.94 (95% CI: 0.86 to 1.02, p<0.001). We also compared the BNP levels with the E/E' in terms of the changes of the functional status for the 42 patients suffering with DHF. After treatment, the blood pressure (BP) was significantly decreased from 162+/-26/91+/-15 to 141+/-16/80+/-12 mmHg (p<0.001), the New York Heart Association (NYHA) functional class was decreased from 2.3+/-0.7 to 1.7+/-0.6 (p<0.001), and the E/E' was decreased from 15.9+/-5.7 to 13.8+/-5.1 (p<0.01), but there were no significant changes of the BNP levels, from 213+/-404 to 208+/-464 pg/mL, following treatment. CONCLUSION: A BNP assay is clinically useful for diagnosing DHF, and a cut-off value of BNP can be suggested for screening DHF. However, the tissue doppler derived E/E' is the better index for monitoring changes in the functional status of DHF patients than is the BNP level.
Ambulatory Care Facilities ; Biomarkers ; Blood Pressure ; Diagnosis* ; Dyspnea ; Echocardiography ; Echocardiography, Doppler ; Emergency Service, Hospital ; Follow-Up Studies* ; Heart ; Heart Failure ; Heart Failure, Diastolic* ; Heart Failure, Systolic ; Humans ; Male ; Mass Screening ; Natriuretic Peptide, Brain* ; Prospective Studies

OBJECTIVETo investigate the clinical features of severe chronic heart failure patients with normal B-type natriuretic peptide (BNP).

METHODSA total of 57 patients with severe chronic heart failure (New York Heart Association class III and IV) were included in this prospective control study from Dec. 2002 to Oct. 2009. Group A included 13 patients with normal BNP (< 100 ng/L) and group B included 44 patients with increased BNP (> 100 ng/L). Group A patients were followup for (19.6 ± 14.7) months and group B patients for (72.5 ± 17.1) months.

RESULTSThe baseline clinical characteristics of two groups were comparable. Left ventricular end diastolic diameter (LVEDd) of group A was larger than group B [(70.56 ± 4.33) mm vs.(63.73 ± 3.75) mm, P < 0.05], the left ventricular ejection fraction (LVEF) of group A was lower than group B [(24.16 ± 2.50)% vs. (28.49 ± 2.63)%, P < 0.05]. The number of patents tolerating metoprolol in group A is lower than in group B (7/13 vs. 39/44, P < 0.05), and the tolerant dose of metoprolol in group A is lower than in group B [(12.5 ± 6.25) mg/d vs. (24.20 ± 11.22) mg/d, P < 0.05]. The level of BNP in group B were significantly higher at acute stages than at remission stages [(962.73 ± 165.00) ng/L vs. (876.24 ± 167.70) ng/L, P < 0.05], but remained unchanged in group A [(74.03 ± 11.18) ng/L vs. (71.38 ± 11.68) ng/L, P > 0.05]. The mortality of group A was higher than group B (11/12 vs. 6/44, P < 0.05). The binary logistic regression analysis (backward) showed that normal B-type natriuretic peptide was an independent predictor of cardiovascular mortality in patients with severe chronic heart failure (OR = 45.488, 95%CI = 5.322 - 388.791).

CONCLUSIONNormal BNP in patients with severe chronic heart failure suggests the exhaustion of BNP secretion and associated poor prognosis.

Aged ; Chronic Disease ; Female ; Heart Failure ; blood ; diagnosis ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Prognosis ; Prospective Studies