Antigen carbohydrate 125 and brain natriuretic peptide serial measurements for risk stratification following an episode of acute heart failure.

Abstract Background The prognostic utility of combining serial measurements of brain natriuretic peptide (BNP) and antigen carbohydrate 125 (CA125) is largely unknown. The aim of this work is to assess the prognostic utility of serial measurements of BNP, CA125, and their optimal combination for predicting long-term mortality, following a hospitalization for acute heart failure (AHF). Methods and results We analyzed 293 consecutive patients admitted with AHF where CA125 and BNP were measured at discharge (T1) and at the first ambulatory visit (T2: median 31days after discharge). Biomarkers were evaluated as snapshot determinations or as serial changes in absolute, relative or categorical ch…

Implicaciones pronósticas del péptido natriurético cerebral en la insuficiencia cardiaca aguda: mortalidad y reingresos hospitalarios

El valor pronostico del peptido natriuretico cerebral (BNP) tras un episodio de insuficiencia cardiaca aguda (ICA) no ha sido totalmente establecido. El objetivo de este trabajo fue evaluar la relacion entre las concentraciones de BNP y la mortalidad y los reingresos por ICA. Analizamos a 569 pacientes ingresados consecutivamente con el diagnostico de ICA. Se determino el BNP tras la estabilizacion inicial del paciente. La relacion entre el BNP y la mortalidad fue evaluada mediante regresion de Cox y la relacion con el reingreso, mediante regresion con ajuste para episodios competitivos. Durante una mediana de seguimiento de 9 (3-18) meses, se registraron 156 muertes (27,4%) y 140 reingreso…

Fracción aminoterminal del propéptido natriurético cerebral y troponina ultrasensible en el dolor torácico agudo de origen incierto. Un subestudio del estudio PITAGORAS

Resumen Introduccion y objetivos La troponina ultrasensible ha mejorado el diagnostico del sindrome coronario agudo en los pacientes que se presentan con dolor toracico y troponina convencional normal. Nuestro objetivo es analizar si la fraccion aminoterminal del propeptido natriuretico cerebral aporta informacion adicional. Metodos Se estudio a 398 pacientes, incluidos en el estudio PITAGORAS, que acudieron a urgencias por dolor toracico con troponina convencional normal en dos muestras seriadas (a la llegada y a las 6-8 h). Se midio de forma centralizada la troponina T ultrasensible en las dos muestras y la fraccion aminoterminal del propeptido natriuretico cerebral en la segunda. Los obj…

Determinants of procalcitonin concentration in acute heart failure.

Age, years 73.1 ± 10.4 Male, n (%) 133 (51.0) Hypertension, n (%) 212 (81.2) Diabetes mellitus, n (%) 126 (49.4) Previous smoker, n (%) 104 (28.2) Ischemic etiology, n (%) 92 (35.3) Peripheral oedema, n (%) 187 (71.7) Previous admission for AHF, n (%) 95 (36.4) Prior use of beta-blockers, n (%) 111 (42.5) Prior use of loop diuretics, n (%) 175 (67.0) Prior use of ACEI/ARB, n (%) 134 (51.3) Heart rate, beats/min 97 ± 28 SBP, mm Hg 148 ± 34 DBP, mm Hg 81 ± 19 Atrial fibrillation, n (%) 119 (45.6) Hemoglobin, g/dl 12.1 ± 2.0 Serum creatinine, mg/dl 1.23 ± 0.57 Urea, mg/dl 60.5 ± 30.1 Sodium, mEq/l 137.8 ± 4.7 NT-proBNP, pg/ml 4813 (6011) Leukocyte count, 10 cells/l 9286 ± 3468 Relative lymphoc…

Qualitative assessment of SARS-CoV-2-specific antibody avidity by lateral flow immunochromatographic IgG/IgM antibody assay.

Abstract Knowledge of the precise timing of SARS‐CoV‐2 infection may be of clinical and epidemiological relevance. The presence of low‐avidity IgGs has conventionally been considered an indicator of recent infection. Here, we carried out qualitative assessment of SARS‐CoV‐2‐specific antibody avidity using an urea (6M) dissociation test performed on a lateral flow immunochromatographic IgG/IgM device. We included a total of 76 serum specimens collected from 57 COVID‐19 patients, of which 39 tested positive for both IgG and IgM and 37 only for IgG. Sera losing IgG reactivity after urea treatment (n = 28) were drawn significantly earlier (P = .04) after onset of symptoms than those which prese…

Optimal carbohydrate antigen 125 cutpoint for identifying low-risk patients after admission for acute heart failure

Introduction and objectives: Carbohydrate antigen 125 (CA125) has been shown to be useful for risk stratification in patients admitted with acute heart failure (AHF). We sought to determine a CA125 cutpoint for identifying patients at low risk of 1-month death or the composite of death/HF readmission following admission for AHF.Methods: The derivation cohort included 3231 consecutive patients with AHF. CA125 cutoff values with 90% negative predictive value (NPV) and sensitivity up to 85% were identified. The adequacy of these cutpoints and the risk of 1-month death/HF readmission was then tested using the Royston-Parmar method. The best cutpoint was selected and externally validated in a co…

Punto de corte óptimo del antígeno carbohidrato 125 para la identificación de pacientes con bajo riesgo tras un ingreso por insuficiencia cardiaca aguda

Resumen Introduccion y objetivos El antigeno carbohidrato 125 (CA125) se ha mostrado util para la estratificacion del riesgo de los pacientes ingresados por insuficiencia cardiaca aguda (ICA). Se intenta determinar un punto de corte para identificar a los pacientes con bajo riesgo de muerte y muerte/reingreso por insuficiencia cardiaca 1 mes tras el ingreso por ICA. Metodos La cohorte de derivacion incluyo a 3.231 pacientes con ICA consecutivos. Se identificaron valores de corte de CA125 con un valor predictivo negativo (VPN) del 90% y una sensibilidad de hasta el 85%. La idoneidad de estos puntos de corte y el riesgo de muerte/reingreso al mes se evaluaron mediante el metodo de Royston-Par…

Improvement in risk stratification with the combination of the tumour marker antigen carbohydrate 125 and brain natriuretic peptide in patients with acute heart failure.

Aim Elevated brain natriuretic peptide (BNP) and tumour marker antigen carbohydrate 125 (CA125) levels have shown to be associated with higher risk for adverse outcomes in patients with acute heart failure (AHF). Nevertheless, no attempt has been made to explore the utility of combining these two biomarkers. We sought to assess whether CA125 adds prognostic value to BNP in predicting 6-month all-cause mortality in patients with AHF. Methods and results We analysed 1111 consecutive patients admitted for AHF. Antigen carbohydrate 125 (U/mL) and BNP (pg/mL) were measured at a median of 72 ± 12 h after instauration of treatment. Antigen carbohydrate 125 and BNP were dichotomized based on propos…

Cell-free DNA and Microvascular Damage in ST-segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention.

INTRODUCTION AND OBJECTIVES Cell-free DNA (cfDNA) in ST-segment elevation myocardial infarction might originate from hyperactivated leukocytes at the coronary lesion. Our aim was to investigate the relationship between cfDNA and coronary reperfusion. METHODS We studied 116 patients treated with primary angioplasty using thrombus aspiration. Coronary (during aspiration) and peripheral (at the end of the procedure) blood samples were drawn for cfDNA, as well as high-sensitivity troponin T and myeloperoxidase quantification. The primary endpoint was no ST-segment resolution (STR) (≥ 70%) and the secondary endpoint was lack of final Thrombolysis In Myocardial Infarction flow 3 (TIMI 3). RESULTS…

Misclassification of subjects with insulin resistance and associated cardiovascular risk factors by homeostasis model assessment index. Utility of a postprandial method based on oral glucose tolerance test

Different methods are available for assessing insulin sensitivity in the fasting state. However, insulin resistance (IR) is initially a postprandial disturbance; and usually, when basal (fasting) disturbance appears, the process has been in progress for some time. Our aim was to investigate if a postprandial measurement, performing an oral glucose tolerance test (OGTT), is more sensitive than fasting values. We wished to identify early IR states in healthy, nonobese individuals and ascertain if this situation was associated with other cardiovascular risk factors. A total of 90 nonobese, nondiabetic, and nonsmoker individuals were studied. They were divided into 3 groups according to IR stat…

Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality

Background: The prognostic value of long-term potassium monitoring and dynamics in heart failure has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of patients discharged from a previous acute heart failure admission. Methods: Serum potassium was measured at every physician-patient encounter, including hospital admissions and ambulatory settings. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modeling. Res…

Similar Clinical Course and Significance of Circulating Innate and Adaptive Immune Cell Counts in STEMI and COVID-19

This study aimed to assess the time course of circulating neutrophil and lymphocyte counts and their ratio (NLR) in ST-segment elevation myocardial infarction (STEMI) and coronavirus disease (COVID)-19 and explore their associations with clinical events and structural damage. Circulating neutrophil, lymphocyte and NLR were sequentially measured in 659 patients admitted for STEMI and in 103 COVID-19 patients. The dynamics detected in STEMI (within a few hours) were replicated in COVID-19 (within a few days). In both entities patients with events and with severe structural damage displayed higher neutrophil and lower lymphocyte counts. In both scenarios, higher maximum neutrophil and lower mi…

ADN libre y daño microvascular en el infarto agudo de miocardio con elevación del segmento ST tratado con intervención coronaria primaria

Resumen Introduccion y objetivos En el infarto agudo de miocardio con elevacion del segmento ST, el ADN libre circulante podria originarse de los leucocitos activados en la lesion coronaria. El objetivo fue investigar la relacion entre el ADN libre y la reperfusion coronaria. Metodos Se incluyo a 116 pacientes, tratados con angioplastia primaria y tromboaspiracion. Se cuantifico el ADN libre coronario (durante la aspiracion) y periferico (al final del procedimiento), asi como la troponina T ultrasensible y la mieloperoxidasa. El objetivo primario fue la no resolucion del segmento ST (RST) (≥ 70%) y el secundario la ausencia de flujo Thrombolysis In Myocardial Infarction 3 (TIMI 3) final. Re…

Diuretic Strategies in Acute Heart Failure and Renal Dysfunction: Conventional vs Carbohydrate Antigen 125-guided Strategy. Clinical Trial Design

Abstract Introduction and objectives The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. Methods Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4 mg/dL on admission will be randomized to: a) standard diuretic str…

Undetectable high-sensitivity troponin in combination with clinical assessment for risk stratification of patients with chest pain and normal troponin at hospital arrival

Background Undetectable high-sensitivity cardiac troponin (hs-cTn) in a single determination upon admission may rule out acute coronary syndrome. We investigated undetectable hs-cTnT (<detection limit; <5 ng/l) together with clinical risk scores (GRACE, TIMI, HEART and a previously published simple score), for one-year outcomes in patients with chest pain and normal hs-cTnT (<99th percentile; <14 ng/l) upon admission. Methods This study was a retrospective design involving 2254 consecutive patients (July 2016–November 2017). The primary endpoint was one-year death or acute myocardial infarction; the secondary endpoint added unstable angina requiring revasculariz…

Growth differentiation factor 15 and geriatric conditions in acute coronary syndrome

Abstract Background Growth differentiation factor 15 (GDF-15) is a marker of cell senescence. Age is a well-known determinant of GDF-15 levels, yet no study has analyzed the relationship between geriatric conditions and GDF-15. We hypothesize that geriatric conditions reflecting biological age might be stronger determinants of GDF-15 than chronological age in elderly patients with acute coronary syndrome. Methods A total of 208 patients (mean age = 78.3 ± 7.0 years) were included. Prior to discharge, a thorough geriatric assessment was performed and GDF-15 measured. Predictors of GDF-15 (transformed by its natural logarithm) were determined with linear regression. Furthermore, Cox regressio…

Estrategias diuréticas en insuficiencia cardiaca aguda con disfunción renal: terapia convencional frente a guiada por el antígeno carbohidrato 125. Diseño de ensayo clínico

Resumen Introduccion y objetivos El tratamiento optimo de pacientes con insuficiencia cardiaca aguda (ICA) y sindrome cardiorrenal tipo 1 (SCR-1) no esta bien definido. La hipoperfusion arterial y la congestion venosa tienen un papel fundamental en la fisiopatologia del SCR-1. El antigeno carbohidrato 125 (CA125) ha emergido como marcador indirecto de sobrecarga de volumen en la ICA. El objetivo de este estudio es evaluar la utilidad del CA125 para el ajuste del tratamiento diuretico de pacientes con SCR-1. Metodos Ensayo clinico multicentrico, abierto y paralelo, que incluye a pacientes con ICA y creatinina ≥ 1,4 mg/dl al ingreso, aleatorizados a: a)  estrategia convencional: titulacion ba…

Usefulness of high-sensitivity troponin T for the evaluation of patients with acute chest pain and no or minimal myocardial damage

Although high-sensitivity troponins allow early diagnosis of acute myocardial infarction, their role for identification of acute coronary syndrome in patients with normal conventional troponin remains unclear.A total of 446 patients presenting to the emergency department with chest pain and normal troponin (common practice assays) in 2 serial samples were included. Both samples were also centrally analyzed for high-sensitivity troponin T (hs-TnT) (Roche Diagnostics, Basel, Switzerland). Detection (3 ng/L) and 99th percentile (≥ 14 ng/L) cutoffs of the maximum hs-TnT levels (hs-TnTmax) were considered. The end points were acute coronary syndrome diagnosis and the composite of in-hospital rev…

Randomized comparison between clinical evaluation plus N-terminal pro–B-type natriuretic peptide versus exercise testing for decision making in acute chest pain of uncertain origin

Background Exercise testing constitutes the usual tool for decision making in chest pain units. This policy implies logistical constrains. Our aim was to evaluate a new strategy, combining a clinical risk score and N-terminal pro–B-type natriuretic peptide (NT-proBNP), in patients presenting to the emergency department with chest pain, without ischemic electrocardiogram changes or troponin elevation. Methods A total of 320 patients were randomized to either usual management, involving exercise testing, or a new strategy combining a clinical risk score and NT-proBNP without exercise testing. In the usual management, discharge decision was guided by the result of exercise test. In the new str…

Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study.

Although the early diagnosis of anastomotic leak is a key point in reducing its clinical consequences, in daily practice, anastomotic leak diagnosis is often late.The aim of this study was to determine whether procalcitonin and C-reactive protein are good predictors of anastomotic leak in colorectal surgery.This is a prospective observational study.This study was conducted by a specialized colorectal multidisciplinary team of a tertiary teaching hospital.A series of 205 consecutive patients who underwent elective colorectal surgery in a specialized unit was prospectively analyzed. The following data were collected: demographic, surgical, ASA class, POSSUM, and morbidity. During the first 5 …

Metabolomic Profile of Human Myocardial Ischemia by Nuclear Magnetic Resonance Spectroscopy of Peripheral Blood Serum

Objectives The aim of this study was to investigate the metabolomic profile of acute myocardial ischemia (MIS) using nuclear magnetic resonance spectroscopy of peripheral blood serum of swine and patients undergoing angioplasty balloon‐induced transient coronary occlusion. Background Biochemical detection of MIS is a major challenge. The validation of novel biosignatures is of utmost importance. Methods High-resolution nuclear magnetic resonance spectroscopy was used to profile 32 blood serum metabolites obtained (before and after controlled ischemia) from swine (n 9) and patients (n 20) undergoing transitory MIS in the setting of planned coronary angioplasty. Additionally, blood serum of c…

Clinical History and Detectable Troponin Concentrations below the 99th Percentile for Risk Stratification of Patients with Chest Pain and First Normal Troponin

Decision-making is challenging in patients with chest pain and normal high-sensitivity cardiac troponin T (hs-cTnT

N-terminal Pro-brain Natriuretic Peptide and High-sensitivity Troponin in the Evaluation of Acute Chest Pain of Uncertain Etiology. A PITAGORAS Substudy

Abstract Introduction and objectives High-sensitivity troponin assays have improved the diagnosis of acute coronary syndrome in patients presenting with chest pain and normal troponin levels as measured by conventional assays. Our aim was to investigate whether N-terminal pro-brain natriuretic peptide provides additional information to troponin determination in these patients. Methods A total of 398 patients, included in the PITAGORAS study, presenting to the emergency department with chest pain and normal troponin levels as measured by conventional assay in 2 serial samples (on arrival and 6 h to 8 h later) were studied. The samples were also analyzed in a central laboratory for high-sensi…

P2516Low relative lymphocyte count as a marker of frailty in patients with acute coronary syndromes

Continuous ambulatory peritoneal dialysis as a promising therapy for light chain amyloidosis with congestive heart failure

Hydrogen- and Methane-Based Breath Testing and Outcomes in Patients With Heart Failure

Background: Recent evidence endorses gut microbiota dysregulation in the pathophysiology of heart failure (HF). Small intestinal bacterial overgrowth (SIBO) might be present in HF and associated with poor clinical outcomes. Lactulose breath testing is a simple noninvasive test that has been advocated as a reliable indicator of SIBO. In patients with HF, we aimed to evaluate the association with clinical outcomes of the exhaled hydrogen (H-2) and methane (CH4) concentrations through the lactulose breath test. Methods and Results: We included 102 patients with HF in which lactulose SIBO breath tests were assessed. Cumulative gas was quantified by the area under the receiver operating characte…

CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction

BACKGROUND: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. METHODS: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-gui…

Procalcitonin and long-term prognosis after an admission for acute heart failure

Abstract Background Traditionally, procalcitonin (PCT) is considered a diagnostic marker of bacterial infections. However, slightly elevated levels of PCT have also been found in patients with heart failure. In this context, it has been suggested that PCT may serve as a proxy for underrecognized infection, endotoxemia, or heightened proinflammatory activity. Nevertheless, the clinical utility of PCT in this setting is scarce. We aimed to evaluate the association between PCT and the risk of long-term outcomes. Methods and results We measured at admission PCT of 261 consecutive patients admitted for acute heart failure (AHF) after excluding active infection. Cox and negative binomial regressi…

Prognostic Value of Brain Natriuretic Peptide in Acute Heart Failure: Mortality and Hospital Readmission

The prognostic value of brain natriuretic peptide (BNP) measurement in patients with acute heart failure is not well understood. The aim of this study was to investigate the relationship between the BNP level and mortality and readmission for acute heart failure. We studied 569 consecutive patients who were admitted with a diagnosis of acute heart failure. The BNP level was measured after the patient became clinically stable. The relationship between the BNP level and mortality was assessed by Cox regression analysis, and the relationship with readmission, by competing risks regression analysis. During a median follow-up period of 9 (range, 3-18) months, 156 deaths (27.4%) and 140 readmissi…

PAI-1 Levels are Related to Insulin Resistance and Carotid Atherosclerosis in Subjects with Familial Combined Hyperlipidemia

Familial combined hyperlipidemia (FCH) is a primary atherogenic dyslipidemia with insulin resistance and increased cardiovascular risk. Plasminogen activator inhibitor type 1 (PAI-1) and myeloperoxidase (MPO) activity are associated with proinflammatory and atherothrombotic risk. Our aim was to study the role played by PAI-1 and MPO activity in the carotid atherosclerosis prevalence in FCH subjects. 36 FCH unrelated subjects (17 women) were matched by age and body weight with 36 healthy normolipidemic subjects (19 female). Blood lipids, glucose, insulin, insulin resistance (homeostasis model assessment (HOMA)), MPO, and PAI-1 were determined in both groups. Carotid intima media thickness (…

Serum neprilysin and recurrent hospitalizations after acute heart failure

Clinical Evaluation Versus Undetectable High-Sensitivity Troponin for Assessment of Patients With Acute Chest Pain.

Decision-making in acute chest pain remains challenging despite normal (below ninety-ninth percentile) high-sensitivity troponin (hs-cTn). Some studies suggest that undetectable hs-cTn, far below the ninety-ninth percentile, might rule out acute coronary syndrome. We investigated clinical data in comparison to undetectable hs-cTnT. The study comprised 682 patients (November 2010 to September 2011) presenting at the emergency department with chest pain and normal hs-cTnT (14 ng/l). The main end point was major adverse cardiac events (MACE: death, myocardial infarction, readmission for unstable angina, or revascularization) at a 4-year median follow-up; secondary end point was 30-day MACE. A …