Laboratorio de Urgencias

Bibliografía

Buenos Aires 01 de Mayo del 2021

Búsqueda Bibliográfica: BNP / proBNP (2017-2018)

1. Postgrad Med. 2018 Apr;130(3):299-307. doi: 10.1080/00325481.2018.1440873. Epub
2018 Mar 29.

Utility of natriuretic peptides to assess and manage patients with heart failure
receiving angiotensin receptor blocker/neprilysin inhibitor therapy.

Maisel AS(1), Daniels LB(2), Anand IS(3), McCullough PA(4)(5), Chow SL(6).

Author information:
(1)a Coronary Care Unit and Heart Failure Program , Veterans Affairs San Diego
Healthcare System , San Diego , CA , USA.
(2)b Sulpizio Cardiovascular Center , University of California , San Diego, La
Jolla , CA , USA.
(3)c Department of Medicine, University of Minnesota Medical School and VA
Medical Center , Minneapolis , MN , USA.
(4)d Baylor Heart and Vascular Institute, and Baylor Jack and Jane Hamilton Heart
and Vascular Hospital , Baylor University Medical Center , Dallas , TX , USA.
(5)e Preventive Cardiology & Advanced Lipidology Clinic , The Heart Hospital
Baylor Plano , Plano , TX , USA.
(6)f Western University of Health Sciences, College of Pharmacy , Pomona , CA ,
USA.

Levels of natriuretic peptides (NPs), such as B-type NP (BNP) and the N-terminal
fragment of its prohormone (NT-proBNP), are well-established biomarkers for
patients with heart failure (HF). Although these biomarkers have consistently
demonstrated their value in the diagnosis and prognostication of HF, their
ability to help clinicians in making treatment decisions remains debated.
Moreover, some new HF drugs can affect concentrations of NPs, such as the
prevention of BNP degradation by angiotensin receptor/neprilysin inhibitors
(ARNIs), and may present a challenge in the interpretation of levels of BNP. Use
of NT-proBNP measurement has been suggested in the context of ARNI therapy
because its concentrations are not affected by neprilysin inhibition. As
biomarkers are reconsidered in the context of ARNI therapy, cutoff levels and the
effects of individual patient characteristics, such as renal function and age, on
biomarker concentrations should be reassessed.

DOI: 10.1080/00325481.2018.1440873
PMID: 29596012 [Indexed for MEDLINE]

2. Presse Med. 2018 Feb;47(2):116-124. doi: 10.1016/j.lpm.2017.12.002. Epub 2018 Feb
27.

[Atrial natriuretic hormones and metabolic syndrome: recent advances].

[Article in French]

Benomar K(1), Espiard S(2), Loyer C(2), Jannin A(2), Vantyghem MC(3).

Author information:
(1)Centre hospitalo-universitaire de Lille, hôpital C-Huriez, service
d'endocrinologie et métabolisme, 1, rue Polonovski, 59037 Lille cedex, France;
UMR 1190 recherche translationnelle sur le diabète Inserm, 59000 Lille, France;
EGID (European Genomic Institute for Diabetes), université de Lille, 59000 Lille,
France.
(2)Centre hospitalo-universitaire de Lille, hôpital C-Huriez, service
d'endocrinologie et métabolisme, 1, rue Polonovski, 59037 Lille cedex, France.
(3)Centre hospitalo-universitaire de Lille, hôpital C-Huriez, service
d'endocrinologie et métabolisme, 1, rue Polonovski, 59037 Lille cedex, France;
UMR 1190 recherche translationnelle sur le diabète Inserm, 59000 Lille, France;
EGID (European Genomic Institute for Diabetes), université de Lille, 59000 Lille,
France. Electronic address: mc-vantyghem@chru-lille.fr.

Natriuretic peptides are a group of hormones including atrial natriuretic peptide
(ANP), brain natriuretic peptide (BNP), C type (CNP), urodilatin and guanilyn.
ANP (half-life: 2-4 min), is secreted by the atrium, BNP (half-life: 20 min) by
the ventricle, CNP by the vascular endothelium, urodilatin by the kidney and
guanylin by the intestine. These natriuretic peptides prevent water and salt
retention through renal action, vasodilatation and hormonal inhibition of
aldosterone, vasopressin and cortisol. These peptides also have a recently
demonstrated metabolic effect through an increase of lipolysis, thermogenesis,
beta cell proliferation and muscular sensitivity to insulin. Blood levels of
these natriuretic peptides depend on "active NPR-A receptors/clearance NPR-C
receptors", the last ones being abundant on adipocytes. Therefore, natriuretic
peptides act as adipose tissue regulator and constitute a link between blood
pressure and metabolic syndrome. They are used as markers and treatment of
cardiac failure. Other applications are on going. BNP and NT-proBNP (inactive
portion de la pro-hormone) are used as markers of cardiac failure since they have
a longer half-life than ANP. BNP decrease is quicker and more important than that
one of NT-ProBNP in case of improvement of cardiac failure. Chronic renal
insufficiency and beta-blockers increase BNP levels. BNP measurement is useless
under treatment with neprilysine inhibitors such as sacubitril, one of the
neutral endopeptidases involved in catabolism of natriuretic peptides. The
association sacubitril/valsartan is a new treatment of chronic cardiac failure,
acting through the decrease of ANP catabolism.

DOI: 10.1016/j.lpm.2017.12.002
PMID: 29496376 [Indexed for MEDLINE]

3. Curr Heart Fail Rep. 2017 Dec;14(6):536-542. doi: 10.1007/s11897-017-0365-5.

Pharmacogenomics of the Natriuretic Peptide System in Heart Failure.

Abuzaanona A(1), Lanfear D(2).

Author information:
(1)Department of Internal Medicine, Henry Ford Hospital, 2799 W. Grand Boulevard,
Detroit, MI, 48202, USA.
(2)Heart and Vascular Institute, Henry Ford Hospital, 2799 W. Grand Boulevard,
Detroit, MI, 48202, USA. dlanfea1@hfhs.org.

PURPOSE OF REVIEW: Heart failure (HF) continues to be a public health burden
despite advances in therapy, and the natriuretic peptide (NP) system is clearly
of critical importance in this setting, spawning valuable diagnostic and
prognostic testing, such as B-type natriuretic peptide (BNP) and N-terminal
pro-BNP (NT-proBNP), as well as current and future therapeutics, including
recombinant natriuretic peptides (e.g., carperitide, nesiritide) and recently
sacubitril, which inhibits the key clearance mechanism for NPs. This article
intends to summarize the existing evidence for the role of NP system genetic
variation on cardiovascular phenotypes relevant to HF with particular focus on
the potential impact on pharmacologic therapies.
RECENT FINDINGS: Several genes in NP system have been interrogated, in many cases
genetic variation impacting protein quantity and function or related disease
states. Recent data supports genetic variants potentially impacting
pharmacokinetics or dynamics of medications targeting the pathway. Growing
evidence indicates the importance of genetic variation to the functioning of the
NP system and its pharmacologic manipulation.

DOI: 10.1007/s11897-017-0365-5
PMCID: PMC5681877 [Available on 2018-12-01]
PMID: 29075957 [Indexed for MEDLINE]

4. Expert Rev Cardiovasc Ther. 2017 Oct;15(10):729-741. doi:
10.1080/14779072.2017.1366312. Epub 2017 Aug 22.

Using biomarkers to guide heart failure management.

Chang KW(1)(2), Fox S(1)(2), Mojaver S(1)(2), Maisel AS(1)(2).

Author information:
(1)a Division of Cardiology, Department of Medicine , University of California ,
San Diego , CA , USA.
(2)b Veterans Affair San Diego Healthcare System , San Diego , CA , USA.

INTRODUCTION: Biomarkers have revolutionized the diagnosis of heart failure (HF),
but it remains unclear how to use biomarkers to guide management of HF. Areas
covered: An exhaustive literature search on using biomarkers to guide HF
management was performed. HF guidelines were carefully scrutinized for references
pertaining to this topic, and Medline was employed to identify further
references. This review focused on natriuretic peptides, troponin, and ST2 as
biomarkers used to guide HF management. Most trials have examined secondary
prevention of chronic HF patients, and data on primary prevention of HF and
therapy of acute HF are emerging. Expert commentary: While the current data on
using biomarkers to guide HF management remain mixed, more research is necessary
to better understand how to utilize biomarkers to improve HF management.

DOI: 10.1080/14779072.2017.1366312
PMID: 28830266 [Indexed for MEDLINE]

5. Am J Med. 2017 Dec;130(12):1351-1357. doi: 10.1016/j.amjmed.2017.08.003. Epub
2017 Aug 16.

Clinical Applications of Biomarkers in Atrial Fibrillation.

Chang KW(1), Hsu JC(1), Toomu A(1), Fox S(1), Maisel AS(2).

Author information:
(1)Division of Cardiology, Department of Medicine, Veterans Affair San Diego
Healthcare System, University of California, San Diego.
(2)Division of Cardiology, Department of Medicine, Veterans Affair San Diego
Healthcare System, University of California, San Diego. Electronic address:
amaisel@ucsd.edu.

While biomarkers have greatly impacted the diagnosis and management of myocardial
infarction and heart failure, the use of biomarkers has been slow to permeate
management of atrial fibrillation. Guideline recommendations on the use of
biomarkers in atrial fibrillation were virtually nonexistent until the 2016
European Society of Cardiology guidelines on atrial fibrillation offered a class
IIb recommendation to consider using biomarkers such as high-sensitivity troponin
and natriuretic peptide to further refine stroke and bleeding risk in atrial
fibrillation patients. Biomarker levels have been associated with incident atrial
fibrillation, postoperative atrial fibrillation, acute atrial fibrillation,
diagnosis of myocardial infarction and heart failure in atrial fibrillation, and
prognosis in atrial fibrillation. This review will offer an in-depth survey of
current evidence on the use of biomarkers in atrial fibrillation and propose
clinical algorithms to aid the internist in using biomarkers in atrial
fibrillation management.

Published by Elsevier Inc.

DOI: 10.1016/j.amjmed.2017.08.003
PMID: 28822701 [Indexed for MEDLINE]

6. Curr Heart Fail Rep. 2017 Oct;14(5):434-443. doi: 10.1007/s11897-017-0358-4.

Novel Biomarkers for the Risk Stratification of Heart Failure with Preserved
Ejection Fraction.

Cypen J(1), Ahmad T(2), Testani JM(2), DeVore AD(3)(4).

Author information:
(1)Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
(2)Section of Cardiovascular Medicine, Yale University School of Medicine, New
Haven, CT, USA.
(3)Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
adam.devore@duke.edu.
(4)Duke Clinical Research Institute, Duke University School of Medicine, 2400
Pratt Street, NP-8064, Durham, NC, 27705, USA. adam.devore@duke.edu.

PURPOSE OF REVIEW: The use of biomarkers in heart failure (HF) is a rapidly
changing field. The purpose of this review is to assess the current evidence of
the use of biomarkers for risk stratification in patients with HF with preserved
ejection fraction (HFpEF).
RECENT FINDINGS: Despite differences in pathophysiology between HF with reduced
ejection fraction and HFpEF, traditional HF biomarkers such as brain natriuretic
peptide and troponin retain prognostic value in most HFpEF-specific populations.
Biomarkers of key pathophysiologic components of HFpEF, such as myocardial
fibrosis, remodeling, and systemic inflammation are also valuable prognostic
markers. Further investigation into HF biomarkers may identify significant
therapeutic targets for the treatment of HFpEF.

DOI: 10.1007/s11897-017-0358-4
PMID: 28803400 [Indexed for MEDLINE]

7. Dis Markers. 2017;2017:1454986. doi: 10.1155/2017/1454986. Epub 2017 Jun 18.

Natriuretic Peptides as Biomarkers for Congestive States: The Cardiorenal
Divergence.

Koratala A(1), Kazory A(1).

Author information:
(1)Division of Nephrology, Hypertension, and Renal Transplantation, University of
Florida, Gainesville, FL, USA.

Congestion represents the primary reason for hospitalization of patients with
heart failure and is associated with adverse outcomes. Fluid overload has been
shown to be inadequately addressed in a significant subset of these patients in
part due to lack of robust, reliable, and readily available biomarkers for
objective assessment and monitoring of therapy. Natriuretic peptides have long
been used in this setting, often in conjunction with other assessment tools such
as imaging studies. Patients presenting with concomitant cardiac and renal
dysfunction represent a unique population with regard to congestion in that the
interactions between the heart and the kidney can affect the utility and
performance of biomarkers of fluid overload. Herein, we provide an overview of
the currently available evidence on the utility of natriuretic peptides in these
patients and discuss the clinical conundrum associated with their use in the
setting of renal dysfunction. We highlight the potential divergence in the role
of natriuretic peptides for assessment of volume status in a subset of patients
with renal dysfunction who receive renal replacement therapy and call for future
research to elucidate the utility of the biomarkers in this setting.

DOI: 10.1155/2017/1454986
PMCID: PMC5494089
PMID: 28701807 [Indexed for MEDLINE]

8. Heart. 2017 Oct;103(20):1569-1577. doi: 10.1136/heartjnl-2017-311295. Epub 2017
Jul 8.

Sacubitril/valsartan: beyond natriuretic peptides.

Singh JSS(1), Burrell LM(2), Cherif M(3), Squire IB(4), Clark AL(5), Lang CC(1).

Author information:
(1)Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical
School, University of Dundee, Dundee, UK.
(2)Department of Medicine, Austin Health, The University of Melbourne, Victoria,
Australia.
(3)Novartis Pharmaceuticals, Frimley Business Park, Frimley, Surrey, UK.
(4)Department of Cardiovascular Sciences, University of Leicester and Leicester
NIHR Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.
(5)Department of Academic Cardiology, University of Hull, Daisy Building, Castle
Hill Hospital, Castle Road, Cottingham, UK.

Natriuretic peptides, especially B-type natriuretic peptide (BNP), have primarily
been regarded as biomarkers in heart failure (HF). However, they are also
possible therapeutic agents due to their potentially beneficial physiological
effects. The angiotensin receptor-neprilysin inhibitor, sacubitril/valsartan,
simultaneously augments the natriuretic peptide system (NPS) by inhibiting the
enzyme neprilysin (NEP) and inhibits the renin-angiotensin-aldosterone system
(RAAS) by blocking the angiotensin II receptor. It has been shown to improve
mortality and hospitalisation outcomes in patients with HF due to left
ventricular systolic dysfunction. The key advantage of sacubitril/valsartan has
been perceived to be its ability to augment BNP, while its other effects have
largely been overlooked. This review highlights the important effects of
sacubitril/valsartan, beyond just the augmentation of BNP. First we discuss how
NPS physiology differs between healthy individuals and those with HF by looking
at mechanisms like the overwhelming effects of RAAS on the NPS, natriuretic
peptide receptor desensitisation and absolute natriuretic deficiency. Second,
this review explores other hormones that are augmented by sacubitril/valsartan
such as bradykinin, substance P and adrenomedullin that may contribute to the
efficacy of sacubitril/valsartan in HF. We also discuss concerns that
sacubitril/valsartan may interfere with amyloid-β homeostasis with potential
implications on Alzheimer's disease and macular degeneration. Finally, we explore
the concept of 'autoinhibition' which is a recently described observation that
humans have innate NEP inhibitory capability when natriuretic peptide levels rise
above a threshold. There is speculation that autoinhibition may provide a surge
of natriuretic and other vasoactive peptides to rapidly reverse decompensation.
We contend that by pre-emptively inhibiting NEP, sacubitril/valsartan is inducing
this surge earlier during decompensation, resulting in the better outcomes
observed.

© Article author(s) (or their employer(s) unless otherwise stated in the text of
the article) 2017. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.

DOI: 10.1136/heartjnl-2017-311295
PMID: 28689178 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: LMB has received consulting
fees from Novartis Pharmaceuticals outside the submitted work and lecture fees
from AstraZeneca. MC is an employee of Novartis Pharmaceuticals UK Ltd. IBS
reports grants and personal fees from Novartis Pharmaceuticals, outside the
submitted work, in advisory boards and educational events. ALC has received
financial support for travel to meetings from Servier and accepted personal fees
from Novartis Pharmaceuticals outside the submitted work. CCL received research
support, lecture fees and consulting fees from Astra Zeneca, other from Bayer,
research support and consulting fees from Novartis Pharmaceuticals and other from
Servier, lecture fees from Merck Sharp & Dohme and research support from Pfizer
and Sanofi outside the submitted work.

9. Curr Pharm Biotechnol. 2017;18(6):491-494. doi:
10.2174/1389201018666170615082510.

An Expanding Role of Biomarkers in Pulmonary Arterial Hypertension.

Yildiz M(1), Sahin A(2), Behnes M(3), Akin İ(3).

Author information:
(1)Department of Cardiology, Anesthesiology and Reanimation, Istanbul University
Cardiology Institute, Istanbul, Turkey.
(2)Department of Cardiology, Bakirkoy Dr. Sadi Konuk Educational and Research
Hospital, Istanbul, Turkey.
(3)Department of Cardiology, Medical Faculty Mannheim, University Heidelberg,
Mannheim, Germany.

BACKGROUND: Pulmonary Arterial Hypertension (PAH) is a chronic disease which may
cause or result from multiple cardiopulmonary disorders. The disease has complex
pathophysiological mechanisms and involves many systematic, cellular and
molecular changes. Therefore, it is crucial to find out underlying mechanisms and
detect biomarkers to achieve early and proper diagnosis, evaluating disease
severity, for follow-up and monitor response to treatment. Many biomarkers for
PAH have been investigated but yet no such biomarker has been found specific and
easily accessible to use for the patients. This review aims to identify an
expanding role of biomarkers in PAH.
METHOD: We searched an expanding role of biomarkers such as asymmetric
dimethylarginine (ADMA), von Willebrand factor (vWF) and endothelin for PAH in
the literature.
RESULTS: Thirty-four actual papers were included in this review for searching an
expanding role of biomarkers in the PAH.
CONCLUSION: The search for a proper biomarker for PAH patients is an ongoing
process. Currently we do not have a PAH-specific, easily accesible, low-priced
biomarker for PAH patients. One of the reasons of that is that PAH has a complex
etiology and the diesase eventually alters multiple systems. So far, only
BNP/NT-proBNP has been mainly approved and widely used for risk assesment in
patients with PAH. Ongoing studies, development in the technology and
understanding the underlying mechanisms in the pathophysiology of PAH, will
eventually lead us to find proper biomarker(s), for PAH, which will also improve
patient outcomes and decrease treatment costs in PAH.

DOI: 10.2174/1389201018666170615082510
PMID: 28641568 [Indexed for MEDLINE]

10. Biomed Pharmacother. 2017 Aug;92:826-835. doi: 10.1016/j.biopha.2017.05.136. Epub
2017 Jun 7.

The multifaceted role of natriuretic peptides in metabolic syndrome.

Santhekadur PK(1), Kumar DP(2), Seneshaw M(2), Mirshahi F(2), Sanyal AJ(3).

Author information:
(1)McGuire Research Institute, McGuire Veterans Affairs Medical Center, Richmond,
VA, USA; Division of Gastroenterology, Hepatology and Nutrition, Virginia
Commonwealth University, Richmond, VA, 23298, USA; Massey Cancer Center, Virginia
Commonwealth University, Richmond, VA, 23298, USA. Electronic address:
prasanna.santhekadur@vcuhealth.org.
(2)Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth
University, Richmond, VA, 23298, USA.
(3)McGuire Research Institute, McGuire Veterans Affairs Medical Center, Richmond,
VA, USA; Division of Gastroenterology, Hepatology and Nutrition, Virginia
Commonwealth University, Richmond, VA, 23298, USA; Massey Cancer Center, Virginia
Commonwealth University, Richmond, VA, 23298, USA. Electronic address:
arun.sanyal@vcuhealth.org.

Due to globalization and sophisticated western and sedentary lifestyle, metabolic
syndrome has emerged as a serious public health challenge. Obesity is
significantly increasing worldwide because of increased high calorie food intake
and decreased physical activity leading to hypertension, dyslipidemia,
atherosclerosis, and insulin resistance. Thus, metabolic syndrome constitutes
cardiovascular disease, type 2 diabetes, obesity, and nonalcoholic fatty liver
disease (NAFLD) and recently some cancers are also considered to be associated
with this syndrome. There is increasing evidence of the involvement of
natriuretic peptides (NP) in the pathophysiology of metabolic diseases. The
natriuretic peptides are cardiac hormones, which are produced in the cardiac
atrium, ventricles of the heart and the endothelium. These peptides are involved
in the homeostatic control of body water, sodium intake, potassium transport,
lipolysis in adipocytes and regulates blood pressure. The three known natriuretic
peptide hormones present in the natriuretic system are atrial natriuretic peptide
(ANP), brain natriuretic peptide (BNP) and c-type natriuretic peptide (CNP).
These three peptides primarily function as endogenous ligands and mainly act via
their membrane receptors such as natriuretic peptide receptor A (NPR-A),
natriuretic peptide receptor B (NPR-B) and natriuretic peptide receptor C (NPR-C)
and regulate various physiological and metabolic functions. This review will shed
light on the structure and function of natriuretic peptides and their receptors
and their role in the metabolic syndrome.

DOI: 10.1016/j.biopha.2017.05.136
PMCID: PMC5737745
PMID: 28599248 [Indexed for MEDLINE]

11. Biomark Med. 2017 May;11(6):503-512. doi: 10.2217/bmm-2016-0232. Epub 2017 Jun 9.

Blood protein biomarkers as diagnostic tool for ischemic stroke: a systematic
review.

Monbailliu T(1), Goossens J(2), Hachimi-Idrissi S(1)(2).

Author information:
(1)Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium.
(2)Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium.

AIM: This systematic review provides a summary of the blood protein biomarkers
that have been studied for the diagnosis of acute ischemic stroke.
MATERIALS & METHODS: An extensive MEDLINE (using PubMed) and Web of Knowledge
search was performed. From the 354 articles found, 42 were eligible for further
analysis and 25 protein biomarkers were examined.
RESULTS: Though many candidate blood-based protein biomarkers were examined, only
two could significantly differentiate ischemic stroke patients from healthy
controls, stroke mimics and hemorrhagic stroke patients.
CONCLUSION: The blood protein biomarkers, brain natriuretic peptide (BNP) and
S100B, were promising biomarkers in diagnosing ischemic stroke. They could be
used in cases of diagnostic uncertainty and/or when less experienced healthcare
personnel are involved.

DOI: 10.2217/bmm-2016-0232
PMID: 28598212 [Indexed for MEDLINE]

12. Medicine (Baltimore). 2017 Jun;96(22):e6825. doi: 10.1097/MD.0000000000006825.

miRNAs as biomarkers for diagnosis of heart failure: A systematic review and
meta-analysis.

Yan H(1), Ma F, Zhang Y, Wang C, Qiu D, Zhou K, Hua Y, Li Y.

Author information:
(1)aDepartment of Pediatric Cardiology, West China Second University Hospital
bMinistry of Education Key Laboratory of Women and Children's Diseases and Birth
Defects, West China Second University Hospital cWest China Medical School
dProgram for Changjiang Scholars and Innovative Research Team in University, West
China Second University Hospital, Sichuan University, Chengdu, China eDepartment
of Cardiology, Boston Children's Hospital, Harvard University, Boston, USA.

BACKGROUND: With the rapid development of molecular biology, the kind of mircoRNA
(miRNA) has been introduced into emerging role both in cardiac development and
pathological procedure. Thus, we conduct this meta-analysis to find out the role
of circulating miRNA as a biomarker in detecting heart failure.
METHODS: We searched PubMed, EMBASE, the Cochrane Central Register of Controlled
Trials, and World Health Organization clinical trials registry center to identify
relevant studies up to August 2016. We performed meta-analysis in a
fixed/random-effect model using Meta-disc 1.4. We used STATA 14.0 to estimate the
publication bias and meta-regression. Besides, we took use of SPSS 17.0 to
evaluate variance between several groups. Information on true positive, false
positive, false negative, and true negative, as well as the quality of research
was extracted.
RESULTS: We use results from 10 articles to analyze the pooled accuracy. The
overall performance of total mixed miRNAs (TmiRs) detection was: pooled
sensitivity, 0.74 (95% confidence interval [CI], 0.72 to 0.75); pooled
specificity, 0.69 (95%CI, 0.67 to 0.71); and area under the summary receiver
operating characteristic curves value (SROC), 0.7991. The miRNA-423-5p
(miR-423-5p) detection was: pooled sensitivity, 0.81 (95%CI, 0.76 to 0.85);
pooled specificity, 0.67 (95%CI, 0.61 to 0.73); and SROC, 0.8600. However, taken
the same patients population, we extracted the data of BNP for detecting heart
failure and performed meta-analysis with acceptable SROC as 0.9291. Among the
variance analysis, the diagnostic performance of miR-423-5p claimed significant
advantages of other pooled results. However, the combination of miRNAs and BNP
could increase the accuracy of detecting of heart failure. Unfortunately, there
was no dramatic advantage of miR-423-5p compared to BNP protocol.
CONCLUSION: Despite interstudy variability, the performance test of miRNA for
detecting heart failure revealed that miR-423-5p demonstrated the potential to be
a biomarker. However, other miRNAs were not able to provide enough evidence on
promising diagnostic value for heart failure based on the current data. Moreover,
the combination of miRNAs and BNP could work as a better method to detection.
Unfortunately, BNP was still the most convinced biomarker for such disease.

DOI: 10.1097/MD.0000000000006825
PMCID: PMC5459698
PMID: 28562533 [Indexed for MEDLINE]

13. Vnitr Lek. Spring 2017;63(4):255-264.

[Novelties in the treatment of heart failure].

[Article in Czech]

Souček F, Novak J.

Heart failure (HF) is a complex clinical syndrome which is manifested by
characteristic symptoms and objective signs of cardiac insufficiency. The
incidence of HF, particularly its chronic form, is estimated 0.4-2 % in the
central and western Europe, with an increase in higher age groups, affecting
10-20 % of the population aged over 80. With respect to its growing incidence and
prevalence, novel modalities of pharmacological and non-pharmacological treatment
are being developed in order to improve quality of life and survival of the
affected patients. This review based on up-to-date guidelines focuses in the
first part on brief description of the possibilities of diagnosing heart failure,
including the novelties arising out from the latest clinical and preclinical
studies (such as soluble ST2, FSTL1, etc), further it concentrates on innovations
in pharmacological treatment of chronic (ivabradine, ARNI, gliflozins) and acute
(ularitide, serelaxin, nesiritide) HF. The last part provides an overview of
available non-pharmacological HF therapeutics options (modulation of cardiac
contraction, influencing the activity of sympathetic and parasympathetic nervous
systems and permanent and temporary device support).Key words: ARNI - ECMO -
gliflozins - heart failure - modulation of sympathetic and parasympathetic
nervous systems - sacubitril-valsartan - therapy.

PMID: 28520449 [Indexed for MEDLINE]

14. Biomed Res Int. 2017;2017:6274854. doi: 10.1155/2017/6274854. Epub 2017 Apr 13.

Efficacy and Safety of L-Carnitine Treatment for Chronic Heart Failure: A
Meta-Analysis of Randomized Controlled Trials.

Song X(1)(2), Qu H(1), Yang Z(3), Rong J(1), Cai W(1), Zhou H(1).

Author information:
(1)Department of Cardiology, Shuguang Hospital, Shanghai University of
Traditional Chinese Medicine, Shanghai 201203, China.
(2)Department of Cardiology, Yancheng Traditional Chinese Medicine Hospital
Affiliated to Nanjing University of Chinese Medicine, Yancheng 224001, China.
(3)Department of Traditional Chinese Medicine, Shanghai Public Health Clinical
Center, Fudan University, Shanghai 201508, China.

Background. Whether additional benefit can be achieved with the use of
L-carnitine (L-C) in patients with chronic heart failure (CHF) remains
controversial. We therefore performed a meta-analysis of randomized controlled
trials (RCTs) to evaluate the effects of L-C treatment in CHF patients. Methods.
Pubmed, Ovid Embase, Web of Science, and Cochrane Library databases, Chinese
National Knowledge Infrastructure (CNKI) database, Wanfang database, Chinese
Biomedical (CBM) database, and Chinese Science and Technology Periodicals
database (VIP) until September 30, 2016, were identified. Studies that met the
inclusion criteria were systematically evaluated by two reviewers independently.
Results. 17 RCTs with 1625 CHF patients were included in this analysis. L-C
treatment in CHF was associated with considerable improvement in overall efficacy
(OR = 3.47, P < 0.01), left ventricular ejection fraction (LVEF) (WMD: 4.14%, P =
0.01), strike volume (SV) (WMD: 8.21 ml, P = 0.01), cardiac output (CO) (WMD:
0.88 L/min, P < 0.01), and E/A (WMD: 0.23, P < 0.01). Moreover, treatment with
L-C also resulted in significant decrease in serum levels of BNP (WMD:
-124.60 pg/ml, P = 0.01), serum levels of NT-proBNP (WMD: -510.36 pg/ml, P <
0.01), LVESD (WMD: -4.06 mm, P < 0.01), LVEDD (WMD: -4.79 mm, P < 0.01), and
LVESV (WMD: -20.16 ml, 95% CI: -35.65 to -4.67, P < 0.01). However, there were no
significant differences in all-cause mortality, 6-minute walk, and adverse events
between L-C and control groups. Conclusions. L-C treatment is effective for CHF
patients in improving clinical symptoms and cardiac functions, decreasing serum
levels of BNP and NT-proBNP. And it has a good tolerance.

DOI: 10.1155/2017/6274854
PMCID: PMC5406747
PMID: 28497060 [Indexed for MEDLINE]

15. Ann Biol Clin (Paris). 2017 Jun 1;75(3):259-267. doi: 10.1684/abc.2017.1235.

Natriuretic peptides: degradation, circulating forms, dosages and new therapeutic
approaches.

Favresse J(1), Gruson D(2).

Author information:
(1)Département de biologie clinique, Cliniques universitaires Saint-Luc et
Université catholique de Louvain, Bruxelles, Belgique.
(2)Département de biologie clinique, Cliniques universitaires Saint-Luc et
Université catholique de Louvain, Bruxelles, Belgique, Pôle de recherche en
endocrinologie, diabète et nutrition, Institut de recherche expérimentale et
clinique, Cliniques universitaires Saint-Luc et Université catholique de Louvain,
Bruxelles, Belgique.

Testing for natriuretic peptides (BNP, NT-proBNP or MR-proANP) is recommended by
the European Society of Cardiology (ESC) since 2005 for the exclusion diagnosis
of acute and chronic heart failure because of very high predictive values.
Natriuretic peptides are produced by the heart in response to high transmural
pressure and/or myocardial ischemia. These peptides circulate in blood of both
healthy subjects and heart failure patients. Mass spectrometry methods allowed
identifying a collection of circulating and degraded forms of BNP, NT-proBNP and
proBNP. Glycosylated forms of NT-proBNP and proBNP have also been identified.
Current immunoassays are lacking analytical specificity due to high
cross-reactivities between circulating forms. Moreover, glycosylation has been
found to interfere with the capacity of antibodies to bind correctly to analytes.
These elements have been taken into account to propose strategies for the
development of new standardized and improved immunoassays. More recently, the
better understanding of the degradation pathways of natriuretic peptides allowed
the raise of new therapeutic approaches for heart failure patients. All these
elements are detailed in this review.

DOI: 10.1684/abc.2017.1235
PMID: 28446390 [Indexed for MEDLINE]

16. Heart Fail Rev. 2017 May;22(3):279-288. doi: 10.1007/s10741-017-9605-8.

Resetting the neurohormonal balance in heart failure (HF): the relevance of the
natriuretic peptide (NP) system to the clinical management of patients with HF.

Rubattu S(1)(2), Triposkiadis F(3).

Author information:
(1)Department of Clinical and Molecular Medicine, School of Medicine and
Psychology, Sapienza University of Rome, Rome, Italy.
rubattu.speranza@neuromed.it.
(2)Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed,
Pozzilli, Italy. rubattu.speranza@neuromed.it.
(3)Department of Cardiology, Larissa University Hospital, Larissa, Greece.

The natriuretic peptide (NP) system, which includes atrial natriuretic peptide,
B-type natriuretic peptide, and C-type natriuretic peptide, has an important role
in cardiovascular homeostasis, promoting a number of physiological effects
including diuresis, vasodilation, and inhibition of the
renin-angiotensin-aldosterone system. Heart failure (HF) is associated with
defects in NP processing and synthesis, and there is a strong relationship
between NP levels and disease state. NPs are useful biomarkers in HF, and their
use in diagnosis and evaluation of prognosis is well established, particularly in
patients with HF with reduced ejection fraction (HFrEF). There has also been
interest in their use to guide disease management and therapeutic decision
making. An understanding of NPs in HF has also resulted in interest in synthetic
NPs for the treatment of HF and in treatments that target neprilysin, a protease
that degrades NPs. A novel drug, the angiotensin receptor neprilysin inhibitor
sacubitril/valsartan (LCZ696), which simultaneously inhibits neprilysin and
blocks the angiotensin II type I receptor, was shown to have a favorable efficacy
and safety profile in patients with HFrEF and has been approved for use in such
patients in Europe and the USA. In light of the development of treatments that
target neprilysin and of recent data in relation to synthetic NPs, it is timely
to review the current understanding of the role of NPs in HF and their use in
diagnosis, evaluating prognosis and guiding treatment, as well as their place in
HF therapy.

DOI: 10.1007/s10741-017-9605-8
PMCID: PMC5438418
PMID: 28378286 [Indexed for MEDLINE]

17. High Blood Press Cardiovasc Prev. 2017 Jun;24(2):115-126. doi:
10.1007/s40292-017-0196-1. Epub 2017 Apr 4.

Cardiac Natriuretic Peptides, Hypertension and Cardiovascular Risk.

Sarzani R(1)(2), Spannella F(3)(4), Giulietti F(3)(4), Balietti P(3)(4), Cocci
G(3)(4), Bordicchia M(3).

Author information:
(1)Internal Medicine and Geriatrics, Department of Clinical and Molecular
Sciences, University "Politecnica delle Marche", Ancona, Italy.
r.sarzani@univpm.it.
(2)Italian National Research Centre on Aging, Hospital "U. Sestilli",
IRCCS-INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.
r.sarzani@univpm.it.
(3)Internal Medicine and Geriatrics, Department of Clinical and Molecular
Sciences, University "Politecnica delle Marche", Ancona, Italy.
(4)Italian National Research Centre on Aging, Hospital "U. Sestilli",
IRCCS-INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.

Prevalence of cardiovascular (CV) disease is increasing worldwide. One of the
most important risk factors for CV disease is hypertension that is very often
related to obesity and metabolic syndrome. The search for key mechanisms, linking
high blood pressure (BP), glucose and lipid dysmetabolism together with higher CV
risk and mortality, is attracting increasing attention. Cardiac natriuretic
peptides (NPs), including ANP and BNP, may play a crucial role in maintaining CV
homeostasis and cardiac health, given their impact not only on BP regulation, but
also on glucose and lipid metabolism. The summa of all metabolic activities of
cardiac NPs, together with their CV and sodium balance effects, may be very
important in decreasing the overall CV risk. Therefore, in the next future,
cardiac NPs system, with its two receptors and a neutralizing enzyme, might
represent one of the main targets to treat these multiple related conditions and
to reduce hypertension and metabolic-related CV risk.

DOI: 10.1007/s40292-017-0196-1
PMCID: PMC5440492
PMID: 28378069 [Indexed for MEDLINE]

18. Med Clin North Am. 2017 May;101(3):507-519. doi: 10.1016/j.mcna.2016.12.010. Epub
2017 Mar 2.

Outpatient Emergencies: Acute Heart Failure.

Mysliwiec M(1), Bonita RE(2).

Author information:
(1)Department of Medicine, Jefferson Heart Institute, Sidney Kimmel Medical
College of Thomas Jefferson University, 925 Chestnut Street, Suite 323A,
Philadelphia, PA 19107, USA.
(2)Department of Medicine, Jefferson Heart Institute, Sidney Kimmel Medical
College of Thomas Jefferson University, 925 Chestnut Street, Suite 323A,
Philadelphia, PA 19107, USA. Electronic address: Raphael.Bonita@jefferson.edu.

Heart failure is an epidemic in the United States and a major health problem
worldwide. The syndrome of acute heart failure is marked by a recent onset of
symptoms usually in terms of days to a few weeks of worsening fatigue, shortness
of breath, orthopnea, swelling, and sudden onset of weight gain. Physicians
caring for patients with heart failure must know the risk factors for this
disease, pathophysiology, symptomatology, important examination findings, key
diagnostic tests, and management approach so as to improve symptoms and reduce
mortality.

DOI: 10.1016/j.mcna.2016.12.010
PMID: 28372710 [Indexed for MEDLINE]

19. Int J Cardiol. 2017 Jul 1;238:151-158. doi: 10.1016/j.ijcard.2017.02.095. Epub
2017 Feb 22.

Risk factors for mortality in patients undergoing hemodialysis: A systematic
review and meta-analysis.

Ma L(1), Zhao S(2).

Author information:
(1)Department of Nephrology, Beijing Chaoyang Hospital, Capital Medical
University, Beijing 100020, China.
(2)Department of Nephrology, Beijing Chaoyang Hospital, Capital Medical
University, Beijing 100020, China. Electronic address: zhaosumei16@163.com.

BACKGROUND: No consensus exists regarding the factors influencing mortality in
patients undergoing hemodialysis (HD). This meta-analysis aimed to evaluate the
impact of various patient characteristics on the risk of mortality in such
patients.
METHODS: PubMed, Embase, and Cochrane Central were searched for studies
evaluating the risk factors for mortality in patients undergoing HD. The factors
included age, gender, diabetes mellitus (DM), body mass index (BMI), previous
cardiovascular disease (CVD), HD duration, hemoglobin, albumin, white blood cell,
C-reactive protein (CRP), parathyroid hormone, total iron binding capacity
(TIBC), iron, ln ferritin, adiponectin, apolipoprotein A1 (ApoA1), ApoA2, ApoA3,
high-density lipoprotein (HDL), total cholesterol, hemoglobin A1c (HbA1c), serum
phosphate, troponin T (TnT), and B-type natriuretic peptide (BNP). Relative risks
with 95% confidence intervals were derived. Data were synthesized using the
random-effects model.
RESULTS: Age (per 1-year increment), DM, previous CVD, CRP (higher versus lower),
ln ferritin, adiponectin (per 10.0μg/mL increment), HbA1c (higher versus lower),
TnT, and BNP were associated with an increased risk of all-cause mortality. BMI
(per 1kg/m2 increment), hemoglobin (per 1d/dL increment), albumin (higher versus
lower), TIBC, iron, ApoA2, and ApoA3 were associated with reduced risk of
all-cause mortality. Age (per 1-year increment), gender (women versus men), DM,
previous CVD, HD duration, ln ferritin, HDL, and HbA1c (higher versus lower)
significantly increased the risk of cardiac death. Albumin (higher versus lower),
TIBC, and ApoA2 had a beneficial impact on the risk of cardiac death.
CONCLUSIONS: Multiple markers and factors influence the risk of mortality and
cardiac death in patients undergoing HD.

DOI: 10.1016/j.ijcard.2017.02.095
PMID: 28341375 [Indexed for MEDLINE]

20. Curr Cardiol Rep. 2017 Apr;19(4):29. doi: 10.1007/s11886-017-0840-3.

Prognostic Biomarkers in Acute Coronary Syndromes: Risk Stratification Beyond
Cardiac Troponins.

Eggers KM(1), Lindahl B(2).

Author information:
(1)Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala
University, S-751 85, Uppsala, Sweden. kai.eggers@ucr.uu.se.
(2)Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala
University, S-751 85, Uppsala, Sweden.

PURPOSE OF REVIEW: Cardiac troponin (cTn) plays an essential role for assessment
of outcome in acute coronary syndrome (ACS). However, the prognostic value of cTn
is not absolute. In this mini-review, we summarize the evidence on the utility of
established biomarkers of left-ventricular dysfunction, hemodynamic stress,
inflammation, and renal dysfunction for risk prediction beyond cTn in ACS.
RECENT FINDINGS: Only few biomarkers consistently demonstrate additive prognostic
value to cTn levels. The B-type natriuretic peptides (NPs) and
growth-differentiation factor-15 (GDF-15) are most promising in this regard.
However, there are uncertainties regarding the role of these biomarkers for
guidance of treatment decisions, and their prognostic increment to cTn levels
measured with high-sensitivity assays is largely unknown. The NPs and GDF-15
provide the strongest prognostic increment to cTn levels in ACS. However, the
role of these biomarkers for clinical decision-making in contemporary settings
has still to be defined.

DOI: 10.1007/s11886-017-0840-3
PMCID: PMC5357245
PMID: 28315120 [Indexed for MEDLINE]

21. Clin Transplant. 2017 Jun;31(6). doi: 10.1111/ctr.12969. Epub 2017 Apr 16.

Brain natriuretic peptide and right heart dysfunction after heart
transplantation.

Talha S(1)(2), Charloux A(1)(2), Piquard F(2), Geny B(1)(2).

Author information:
(1)Department of Physiology and Functional Explorations, Hôpitaux Universitaires
de Strasbourg, Strasbourg, France.
(2)Equipe d'Accueil 3072, Université de Strasbourg, Strasbourg, France.

Heart transplantation (HT) should normalize cardiac endocrine function, but brain
natriuretic peptide (BNP) levels remain elevated after HT, even in the absence of
left ventricular hemodynamic disturbance or allograft rejection. Right ventricle
(RV) abnormalities are common in HT recipients (HTx), as a result of engraftment
process, tricuspid insufficiency, and/or repeated inflammation due to iterative
endomyocardial biopsies. RV function follow-up is vital for patient management as
RV dysfunction is a recognized cause of in-hospital death and is responsible for
a worse prognosis. Interestingly, few and controversial data are available
concerning the relationship between plasma BNP levels and RV functional
impairment in HTx. This suggests that infra-clinical modifications, such as
subtle immune system disorders or hypoxic conditions, might influence BNP
expression. Nevertheless, due to other altered circulating molecular forms of
BNP, a lack of specificity of BNP assays is described in heart failure patients.
This phenomenon could exist in HT population and could explain elevated BNP
plasmatic levels despite a normal RV function. In clinical practice,
intra-individual change in BNP over time, rather than absolute BNP values, might
be more helpful in detecting right cardiac dysfunction in HTx.

DOI: 10.1111/ctr.12969
PMID: 28314080 [Indexed for MEDLINE]

22. Curr Opin Anaesthesiol. 2017 Jun;30(3):418-425. doi:
10.1097/ACO.0000000000000468.

Anesthesia in adults with congenital heart disease.

Baehner T(1), Ellerkmann RK.

Author information:
(1)Department of Anesthesiology and Intensive Care, University Hospital Bonn,
Bonn, Germany.

PURPOSE OF REVIEW: The current review focuses on patients with congenital heart
disease (CHD) with regard to recent trends in global demographics, healthcare
provision for noncardiac surgery, as well as anesthetic and perioperative care
for these patients.
RECENT FINDINGS: About 40 years after milestones of surgical innovation in CHD,
the number of adults with CHD (ACHD) now surpasses those of children with CHD.
This development leads to the fact that even patients with complex CHD managed
for noncardiac surgery are not restricted to highly specialized centers. However,
preoperative risk assessment for anesthesia in these patients is complex due to
underlying cardiac morbidity and substantial CHD-associated noncardiac morbidity.
In addition to clinical assessment and echocardiography, biomarker measurement
may be a clinically useful tool to estimate severity of heart failure in CHD
patients. The high negative predictive value of NT-proBNP makes it particularly
valuable as a screening tool. Further, morbidity and mortality in ACHD patients
are mainly caused by arrhythmias and therefore are also relevant for
perioperative management. Adverse events and perioperative death in ACHD patients
in cardiac and noncardiac surgery are frequently related to intraoperative
anesthetic care.
SUMMARY: Medical progress in treatment of CHD has shifted morbidity and mortality
of these patients largely to adulthood. Future investigations including risk
stratification of ACHD patients are necessary to further improve perioperative
management, especially for low-risk and high-risk noncardiac management.

DOI: 10.1097/ACO.0000000000000468
PMID: 28306681 [Indexed for MEDLINE]

23. Dtsch Med Wochenschr. 2017 Mar;142(5):346-355. doi: 10.1055/s-0042-117368. Epub
2017 Mar 10.

[Indications and Clinical Implications of the Use of the Cardiac Markers BNP and
NT-proBNP].

[Article in German]

Luchner A(1), von Haehling S(2), Holubarsch C(3), Keller T(4), Knebel F(5), Zugck
C(6), Laufs U(7).

Author information:
(1)Klinik für Innere Medizin I (Kardiologie, Angiologie, Nephrologie,
Pneumologie, Internistische Intensivmedizin), Klinikum St. Marien, Amberg.
(2)Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen,
Georg-August-Universität Göttingen, Göttingen.
(3)Park-Klinikum, Bad Krozingen.
(4)Goethe University Frankfurt, Department of Internal Medicine III, Division of
Cardiology, Frankfurt am Main.
(5)Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Campus Mitte,
Charité - Universitätsmedizin Berlin.
(6)Internistische Gemeinschaftspraxis Steiner Thor, Straubing.
(7)Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische
Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg.

B-type natriuretic peptides are markers of myocardial wall stress. BNP or
NT-proBNP are used for the differential diagnosis of acute dyspnoe where normal
serum concentrations make a cardiac cause unlikely. New data show their
importance for risk prediction in different stages of heart failure and in
primary prevention. Natriuretic peptide guided therapy improves titration of
heart failure medications. Compared to BNP, NT-proBNP is better suited during
therapy with the new angiotensin-rezeptor-neprilysin-inhibitor
Sacubitril/Valsartan. This review article summarizes current data on the
importance of B-type natriuretic peptides for the interface of ambulatory and
hospital care and presents recommendations for their practical use in patient
care.

DOI: 10.1055/s-0042-117368
PMID: 28282683 [Indexed for MEDLINE]

24. Heart Fail Clin. 2017 Apr;13(2):381-401. doi: 10.1016/j.hfc.2016.12.009.

Alternative Biomarkers for Combined Biology.

Kim YH(1), Kirsop J(2), Tang WH(3).

Author information:
(1)Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, Heart
and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA; Cardiovascular
Medicine, Korea University College of Medicine, Korea University Medical Center
Ansan Hospital, 123 Jeokgeum-ro, Ansan-si 15355, Korea.
(2)Department of Cellular and Molecular Medicine, Lerner Research Institute,
Cleveland Clinic, Cleveland, OH, USA.
(3)Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, Heart
and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA; Department of
Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic,
Cleveland, OH, USA; Center for Clinical Genomics, Cleveland Clinic, Cleveland,
OH, USA. Electronic address: tangw@ccf.org.

Chemotherapy-related cardiac dysfunction (CRCD) has challenged clinicians to
hesitate in using cardiotoxic agents such as anthracycline and several protein
kinase inhibitors. As early detection of CRCD and timely cessation of cardiotoxic
agents became a strategy to avoid CRCD, cardiac troponin and natriuretic peptide
are measured to monitor cardiotoxicity; however, there are inconsistencies in
their predictability of CRCD. Alternative biomarkers have been researched
extensively for potential use as more sensitive and accurate biomarkers. The
mechanisms of CRCD and previous studies on traditional and novel biomarkers for
CRCD are examined to enlighten future direction of investigation in this combined
biology.

DOI: 10.1016/j.hfc.2016.12.009
PMCID: PMC5347470
PMID: 28279423 [Indexed for MEDLINE]

25. Handb Exp Pharmacol. 2017;243:79-108. doi: 10.1007/164_2016_86.

Biomarkers of Heart Failure with Preserved and Reduced Ejection Fraction.

Senni M(1)(2), D'Elia E(3), Emdin M(4)(5), Vergaro G(4)(5).

Author information:
(1)Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda
Ospedaliera Papa Giovanni XXIII, Bergamo, Italy. msenni@hpg23.it.
(2)CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo,
Italy. msenni@hpg23.it.
(3)CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo,
Italy.
(4)Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
(5)Fondazione Toscana G. Monasterio, Pisa, Italy.

Biomarkers are increaingly being used in the management of heart failure not only
for the purpose of screening, diagnosis, and risk stratification, but also as a
guide to evaluate the response to treatment in the individual patient and as an
entry criterion and/or a surrogate marker of efficacy in clinical trials testing
novel drugs. In this chapter, we review the role of established biomarkers for
heart failure management, according to the main classification of HF phenotypes,
based on the measurement of left ventricular ejection fraction, including heart
failure with reduced (<40%), preserved (≥50%), and, as recently proposed,
mid-range (40-49%) ejection fraction.

DOI: 10.1007/164_2016_86
PMID: 28181009 [Indexed for MEDLINE]

26. Swiss Med Wkly. 2017 Feb 6;147:w14400. doi: 10.4414/smw.2017.14400. eCollection
2017 Feb 6.

Obstructive sleep-disordered breathing, enuresis and combined disorders in
children: chance or related association?

Zaffanello M(1), Piacentini G(1), Lippi G(2), Fanos V(3), Gasperi E(1), Nosetti
L(4).

Author information:
(1)Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics,
Paediatric Division, University of Verona, Italy.
(2)Section of Clinical Biochemistry, University of Verona, Italy.
(3)Department of Surgical Sciences, University of Cagliari, Italy.
(4)Department of Paediatrics, University of Insubria, Varese, Italy.

Nocturnal enuresis is usually diagnosed and treated by a primary paediatrician or
family practitioner; if there is any doubt, the children may be referred to a
paediatric urologist. Obstructive sleep-disordered breathing is a complex,
multifactorial disorder. Adenotonsillar hypertrophy is considered an important
factor associated with obstructive sleep apnoea syndrome. Enuresis and
obstructive sleep-disordered breathing are both frequent problems of sleep in
childhood. We conducted an electronic search in Medline, Scopus and the ISI Web
of Science to look for published material and identify a putative link between
nocturnal enuresis and obstructive sleep-disordered breathing. A total number of
98 documents were found, but 24 of these had to be excluded after an attentive
reading of the title, abstract or full text because the information therein was
not suitable for the aims of our search. Studies have found that children with
obstructive sleep apnoea syndrome frequently also have nocturnal enuresis. Both
disorders have an underlying sleep disturbance characterised by an altered
arousal response and sleep fragmentation. The pathophysiology of enuretic events
is seemingly linked to nocturnal obstructive events, causing increased
intra-abdominal pressure and altered systemic blood pressure that induces
natriuresis and polyuria by altering levels of antidiuretic hormone, and atrial
and brain natriuretic peptides. We found 17 studies regarding the urological
outcome of treatment for obstructive sleep-disordered breathing in children with
enuresis. Although a vast amount of information is now available regarding the
relationship between nocturnal enuresis and obstructive sleep-disordered
breathing, many of the published studies were uncontrolled, retrospective or
prospective cohort studies (grade C recommendation). Resolution of enuresis after
medical or surgical treatment for obstructive sleep-disordered breathing has been
emphasised. Consequently, symptoms such as snoring, sleep apnoeas and restless
sleep should be sought for all children with enuresis. Confirmed obstructive
sleep-disordered breathing should be treated promptly; subsequently, the
persistence of enuresis requires treatment following the standard protocol.

DOI: 10.4414/smw.2017.14400
PMID: 28165541 [Indexed for MEDLINE]

27. Ann Clin Biochem. 2017 Jul;54(4):420-431. doi: 10.1177/0004563217694377. Epub
2017 May 15.

A systematic evaluation of immunoassay point-of-care testing to define impact on
patients' outcomes.

Pecoraro V(1)(2), Banfi G(3)(4), Germagnoli L(5), Trenti T(1).

Author information:
(1)1 Department of Laboratory Medicine, Clinical Pathology-Toxicology, Ospedale
Civile Sant'Agostino Estense, Modena, Italy.
(2)2 Laboratory of Regulatory Policies, IRCCS - "Mario Negri", Institute of
Pharmacological Research, Milan, Italy.
(3)3 Vita-Salute San Raffaele University, Milan, Italy.
(4)4 I.R.C.C.S. Orthopedic Institute Galeazzi, Milan, Italy.
(5)5 Synlab Italia, Brescia, Italy.

Background Point-of-care testing has been developed to provide rapid test
results. Most published studies focus on analytical performance, neglecting its
impact on patient outcomes. Objective To review the analytical performance and
accuracy of point-of-care testing specifically planned for immunoassay and to
evaluate the impact of faster results on patient management. Methods A search of
electronic databases for studies reporting immunoassay results obtained in both
point-of-care testing and central laboratory scenarios was performed. Data were
extracted concerning the study details, and the methodological quality was
assessed. The analytical characteristics and diagnostic accuracy of six
points-of-care testing: troponin, procalcitonin, parathyroid hormone, brain
natriuretic peptide, C-reactive protein and neutrophil gelatinase-associated
lipocalin were evaluated. Results A total of 116 scientific papers were analysed.
Studies measuring procalcitonin, parathyroid hormone and neutrophil
gelatinase-associated lipocalin reported a limited impact on diagnostic
decisions. Seven studies measuring C-reactive protein claimed a significant
reduction of antibiotic prescription. Several authors evaluated brain natriuretic
peptide or troponin reporting faster decision-making without any improvement in
clinical outcome. Forty-four per cent of studies reported analytical data,
showing satisfactory correlations between results obtained through point-of-care
testing and central laboratory setting. Half of studies defined the diagnostic
accuracy of point-of-care testing as acceptable for troponin (median sensitivity
and specificity: 74% and 94%, respectively), brain natriuretic peptide (median
sensitivity and specificity: 82% and 88%, respectively) and C-reactive protein
(median sensitivity and specificity 85%). Conclusions Point-of-care testing
immunoassay results seem to be reliable and accurate for troponin, brain
natriuretic peptide and C-reactive protein. The satisfactory analytical
performance, together with an excellent practicability, suggests that it could be
a consistent tool in clinical practice, but data are lacking regarding the
patient outcomes.

DOI: 10.1177/0004563217694377
PMID: 28135840 [Indexed for MEDLINE]

28. Clin Orthop Relat Res. 2017 Jun;475(6):1730-1736. doi: 10.1007/s11999-017-5245-5.
Epub 2017 Jan 18.

Does N-terminal Pro-brain Type Natriuretic Peptide Predict Cardiac Complications
After Hip Fracture Surgery?

Ushirozako H(1), Ohishi T(2), Fujita T(2), Suzuki D(2), Yamamoto K(3), Banno
T(4), Takase H(5), Matsuyama Y(4).

Author information:
(1)Department of Orthopaedic Surgery, Fujinomiya City Hospital, 3-1 Nishiki-Cho,
Fujinomiya, Shizuoka, 418-0076, Japan. verisa0808@gmail.com.
(2)Department of Orthopaedic Surgery, Enshu Hospital, Hamamatsu, Shizuoka, Japan.
(3)Department of Orthopaedic Surgery, Shintoshi Hospital, Iwata, Shizuoka, Japan.
(4)Department of Orthopaedic Surgery, Hamamatsu University School of Medicine,
Higashi-Ku, Hamamatsu, Shizuoka, Japan.
(5)Department of Internal Medicine, Enshu Hospital, Naka-Ku, Hamamatsu, Shizuoka,
Japan.

Comment in
Clin Orthop Relat Res. 2017 Jun;475(6):1737-1739.

BACKGROUND: Elderly patients with hip fracture are at risk for cardiac
complications. N-terminal pro-brain type natriuretic peptide (NT-proBNP) has been
shown to predict cardiac complications in surgical patients; however, to our
knowledge, only two studies have evaluated the utility of this test in patients
with hip fracture. We believe it is important to assess a more accurate cutoff
value of NT-proBNP with exclusion of patients with renal failure.
QUESTIONS/PURPOSES: To assess the association between preoperative NT-proBNP and
cardiac complications after hip fracture surgery.
METHODS: We performed 450 surgical procedures in patients with hip fractures
between January 2011 and December 2014. Exclusion criteria were renal dysfunction
and inadequate laboratory tests. The final study population consisted of 328
patients (mean age, 83 years; 80% women). Preoperatively, measurement of
NT-proBNP level was performed. The primary endpoint was the occurrence of cardiac
complications within 14 days after surgery based on a chart review. The
predictive value of NT-proBNP was assessed using multivariate logistic regression
analysis, controlling for relevant confounding variables such as age, gender,
body weight, and renal function; we also performed receiver operating
characteristic (ROC) curve analysis. Postoperative cardiac complications were
encountered in 7% of patients (24 of 328).
RESULTS: The median preoperative NT-proBNP level was higher in patients with
complications than in those without (1090 [interquartile range, 614-3191 pg/mL]
vs 283 pg/mL [interquartile range, 137-507 pg/mL], p < 0.001). The cutoff level
of NT-proBNP determined by ROC curve analysis was 600 pg/mL, with a sensitivity,
specificity, positive predictive value, and negative predictive value of 79%,
81%, 25%, and 98%, respectively, and the area under the ROC curve was 0.87 (95%
CI, 0.80-0.94; p < 0.001). After controlling for potentially relevant confounding
variables, we found a preoperative NT-proBNP greater than 600 pg/mL was
associated with an increased risk of cardiac complications (odds ratio, 13; 95%
CI, 4-38; p < 0.001) compared with those with NT-proBNP less t