natriuretic-peptide--brain and Angina--Stable

Troponin and B-type natriuretic peptide (BNP) concentrations are associated with cardiovascular risk in stable patients. Understanding their determinants and identifying modifiable clinical targets may improve outcomes. We aimed to establish clinical and cardiac determinants of these biomarkers.. This was a prespecified substudy from the randomised Scottish Computed Tomography of the Heart trial, which enrolled patients 18-75 years with suspected stable angina between 2010 and 2014 (NCT01149590). We included patients from six centres in whom high-sensitivity troponin I and BNP were measured (Singulex Erenna). Patients with troponin >99th centile upper reference limit (10.2 ng/L) or BNP ≥400 ng/L were excluded to avoid inclusion of patients with myocardial injury or heart failure. Multivariable linear regression models were constructed with troponin and BNP as dependent variables.. In total, 885 patients were included; 881 (99%) and 847 (96%) had troponin and BNP concentrations above the limit of detection, respectively. Participants had a slight male preponderance (n=513; 56.1%), and the median age was 59.0 (IQR 51.0-65.0) years. The median troponin and BNP concentrations were 1.4 (IQR 0.90-2.1) ng/L and 29.1 (IQR 14.0-54.0) ng/L, respectively. Age and atherosclerotic burden were independent predictors of both biomarkers. Male sex, left ventricular mass and systolic blood pressure were independent predictors of increased troponin. In contrast, female sex and left ventricular volume were independent predictors of increased BNP.. Troponin and BNP are associated with coronary atherosclerosis but have important sex differences and distinct and contrasting associations with CT-determined left ventricular mass and volume.. NCT01149590; Post-results.

Topics: Adolescent; Adult; Aged; Angina, Stable; Biomarkers; Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Severity of Illness Index; Sex Factors; Troponin I; Up-Regulation; Young Adult

In coronary artery disease (CAD), circulating angiogenic factors have been seen to increase, possibly as a response to ischaemia. Regular physical activity (PA) is recommended for prevention and treatment of CAD, but more research is needed to optimise PA regimes. We investigated the effect of home-based high frequency exercise (HFE) on angiogenic cytokines and cardiac markers in patients with stable CAD.. This was a randomised case-control study. Sixty-two patients, with stable CAD, were randomised to HFE (n = 33), (aerobic exercise 70% of max, 30 min, five times/week and resistance exercise three times/week), performed at home, or usual lifestyle (control, n = 29). After eight weeks, percutaneous coronary intervention (PCI) was performed in both groups, and the HFE group continued another six months of exercise. Serum vascular endothelial growth factor (VEGF) and stromal derived factor-1 (SDF-1), plasma N-terminal-brain natriuretic peptide (NT-proBNP), high-sensitive troponin T (TnT) and copeptin were analysed.. Data are presented as median (25(th), 75(th) percentile) of relative changes (%) from baseline. Values of p are given for the difference between the HFE and controls. HFE decreased circulating VEGF levels, before PCI (-5% (-15%, -2%)), while VEGF levels increased in the control group (5% (-3%, 20%) p = 0.004). A significant difference in VEGF remained at three months post-PCI (HFE (-1%(-12%, 5%), control (7% (0%, 14%), p = 0.04), but not at six months after PCI. SDF-1, NT-proBNP, TnT and copeptin levels did not differ significantly. In addition, VEGF levels were positively correlated to NT pro-BNP.. Home-based HFE decreased circulating VEGF in patients with stable CAD, suggesting a reduced ischaemic burden. HFE does not increase markers of cardiac dysfunction, suggesting that it is a safe therapeutic intervention in these patients.

Topics: Aged; Angina, Stable; Angiogenesis Inducing Agents; Biomarkers; Case-Control Studies; Chemokine CXCL12; Exercise; Female; Glycopeptides; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Troponin T; Vascular Endothelial Growth Factor A

This study aimed to evaluate the effects of short-term (60-d) oral supplementation with calcium fructoborate, resveratrol, and their combination on the clinical and biological statuses of subjects with stable angina pectoris.. A randomized, double-blinded, active-controlled, parallel clinical trial was conducted in three groups of subjects. Of the total number of subjects included in study (n = 166), 87 completed the 60-d test treatment study period and 29 followed in parallel their usual medical care and treatment. The primary outcomes were inflammation biomarkers (high-sensitivity C-reactive protein), left ventricular function markers (N-terminal prohormone of brain natriuretic peptide), and lipid markers (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triacylglycerols). Quality of life was assessed by the Canadian Cardiovascular Society angina class and the number of angina attacks per week.. There was a significant decrease of high-sensitivity C-reactive protein in all groups at the 30-d and 60-d visits. This decrease was greater (39.7% at 60 d) for group 3 (calcium fructoborate), followed by group 2 (resveratrol plus calcium fructoborate, 30.3% at 60 d). The N-terminal prohormone of brain natriuretic peptide was significantly lowered by resveratrol (group 1, 59.7% at 60 d) and by calcium fructoborate (group 3, 52.6% at 60 d). However, their combination (group 2) was the most effective and induced a decrease of 65.5%. Lipid markers showed slight changes from baseline in all groups. The improvement in the quality of life was best observed for subjects who received the resveratrol and calcium fructoborate mixture (group 2).. The results indicate that the combination of resveratrol and calcium fructoborate has beneficial effects in patients with angina

Topics: Administration, Oral; Aged; Angina, Stable; Borates; C-Reactive Protein; Dietary Supplements; Double-Blind Method; Female; Fructose; Humans; Inflammation Mediators; Lipids; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Quality of Life; Resveratrol; Stilbenes

Glucose intolerance (GI), defined as either prediabetes or diabetes, promotes cardiovascular events in patients with myocardial infarction (MI). Using the pooled clinical data from patients with MI and GI in the completed ABC and PPAR trials, we aimed to identify their clinical risk factors for cardiovascular events.. Using the limitless-arity multiple testing procedure, an artificial intelligence (AI)-based data mining method, we analyzed 415,328 combinations of < 4 clinical parameters.. We identified 242 combinations that predicted the occurrence of hospitalization for (1) percutaneous coronary intervention for stable angina, (2) non-fatal MI, (3) worsening of heart failure (HF), and (4) all causes, and we analyzed combinations in 1476 patients. Among these parameters, the use of proton pump inhibitors (PPIs) or plasma glucose levels > 200 mg/dl after 2 h of a 75 g oral glucose tolerance test were linked to the coronary events of (1, 2). Plasma BNP levels > 200 pg/dl were linked to coronary and cardiac events of (1, 2, 3). Diuretics use, advanced age, and lack of anti-dyslipidemia drugs were linked to cardiovascular events of (1, 3). All of these factors were linked to (4). Importantly, each finding was verified by independently drawn Kaplan-Meier curves, indicating that the determined factors accurately affected cardiovascular events.. In most previous MI patients with GI, progression of GI, PPI use, or high plasma BNP levels were linked to the occurrence of coronary stenosis or recurrent MI. We emphasize that use of AI may comprehensively uncover the hidden risk factors for cardiovascular events.

Topics: Aged; Angina, Stable; Artificial Intelligence; Biomarkers; Blood Glucose; Coronary Artery Disease; Data Mining; Databases, Factual; Female; Glucose Intolerance; Heart Failure; Hospitalization; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Prognosis; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Recurrence; Retrospective Studies; Risk Factors

Increased B-type natriuretic peptide (BNP) level has been suggested to improve clinical predictions of coronary events and all-cause mortality. We aimed to analyze the relationship between BNP levels and coronary plaque subtypes as detected by coronary computed tomography angiography (CCTA). 402 subjects undergoing CCTA were enrolled. The relationship between increased levels of BNP and plaque subtypes was tested using multivariable linear and logistic regression analysis. Plaques were categorized into subtypes of calcified, mixed and non-calcified. Coronary plaque was observed in 93 of 402 individuals. The participants were divided into three groups according to their serum BNP levels. Compared to those with low BNP level, subgroup with high BNP level had increased prevalence of all plaque types and mixed calcified arterial plaque (MCAP). Multivariable logistic regression analysis suggested increased BNP level predicted the MCAP. Multivariable logistic regression analysis between the presence of ≥2 plaques and BNP indicated that, subgroup with high BNP level was more likely to have MCAP than low BNP level. Our study suggests that increased BNP level is associated with MCAP detected by CCTA. Increased BNP level provides additional information about coronary artery disease in patients with stable chest pain detected by CCTA.

Topics: Angina, Stable; Biomarkers; Chi-Square Distribution; China; Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Cross-Sectional Studies; Double-Blind Method; Female; Humans; Linear Models; Logistic Models; Male; Middle Aged; Multidetector Computed Tomography; Multivariate Analysis; Natriuretic Peptide, Brain; Odds Ratio; Plaque, Atherosclerotic; Predictive Value of Tests; Prevalence; Prognosis; Risk Factors

Circulating levels of high-sensitivity cardiac troponin T (hs-cTnT) and N terminal pro brain natriuretic peptide (NT-proBNP) are predictors of prognosis in patients with coronary artery disease (CAD). We aimed at evaluating the effect of coronary atherosclerosis and myocardial ischemia on cardiac release of hs-cTnT and NT-proBNP in patients with suspected CAD.. Hs-cTnT and NT-proBNP were measured in 378 patients (60.1±0.5 years, 229 males) with stable angina and unknown CAD enrolled in the Evaluation of Integrated Cardiac Imaging (EVINCI) study. All patients underwent stress imaging to detect myocardial ischemia and coronary computed tomographic angiography to assess the presence and characteristics of CAD. An individual computed tomographic angiography score was calculated combining extent, severity, composition, and location of plaques. In the whole population, the median (25-75 percentiles) value of plasma hs-cTnT was 6.17 (4.2-9.1) ng/L and of NT-proBNP was 61.66 (31.2-132.6) ng/L. In a multivariate model, computed tomographic angiography score was an independent predictor of the plasma hs-cTnT (coefficient 0.06, SE 0.02; P=0.0089), whereas ischemia was a predictor of NT-proBNP (coefficient 0.38, SE 0.12; P=0.0015). Hs-cTnT concentrations were significantly increased in patients with CAD with or without myocardial ischemia (P<0.005), whereas only patients with CAD and ischemia showed significantly higher levels of NT-proBNP (P<0.001).. In patients with stable angina, the presence and extent of coronary atherosclerosis is related with circulating levels of hs-cTnT, also in the absence of ischemia, suggesting an ischemia-independent mechanism of hs-cTnT release. Obstructive CAD causing myocardial ischemia is associated with increased levels of NT-proBNP.

Topics: Angina, Stable; Biomarkers; Chi-Square Distribution; Coronary Angiography; Coronary Artery Disease; Echocardiography, Stress; Europe; Female; Humans; Linear Models; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Myocardial Ischemia; Myocardial Perfusion Imaging; Natriuretic Peptide, Brain; Peptide Fragments; Positron-Emission Tomography; Predictive Value of Tests; Severity of Illness Index; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Troponin T

Fractalkine (FKN) was recently shown to play an important role in atherosclerotic plaque rupture and cardiac remodeling and dysfunction. We evaluated the changes in serum FKN (sFKN) in patients with acute ST-elevation myocardial infarction (STEMI) and the influence of a percutaneous coronary intervention (PCI) on the levels of sFKN.. The study population included 40 patients with acute STEMI [acute myocardial infarction (AMI)+PCI: 20 underwent primary PCI; AMI: 20 without PCI] and 40 patients with symptomatic stable angina pectoris (SAP+PCI: 20 underwent PCI; SAP: 20 without PCI). sFKN were measured at different time points by ELIZA. The gene expression of heart FKN was assessed by real-time reverse transcription-PCR in a model of myocardial infarction mice.. We found that the baseline level of sFKN in patients with acute STEMI was significantly higher than that of patients with SAP. Primary PCI in STEMI resulted in a rapid decrease within 24 h and to a similar level after 48 h as in the SAP and SAP+PCI patients, whereas in the AMI group, the sFKN level showed a slight decrease from 6 to 24 h (from 1307.6±368.9 to 1092.7±258.1 pg/ml, P=0.036) and remained significantly higher at all later time points (P<0.001 for all). The sFKN level at 30 days was correlated positively with the NT-proBNP level (r=0.490, P=0.014). The time course of myocardial FKN gene expression in mice has a pattern similar to sFKN change in AMI patients.. Our study suggested that STEMI had a higher sFKN level and correlated positively with the NT-proBNP level at 1 month. PCI could lead to a rapid decrease in the sFKN level.

Topics: Aged; Angina, Stable; Animals; Biomarkers; Chemokine CX3CL1; Disease Models, Animal; Enzyme-Linked Immunosorbent Assay; Female; Humans; Male; Mice, Inbred C57BL; Middle Aged; Myocardial Infarction; Myocardium; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Real-Time Polymerase Chain Reaction; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Time Factors; Treatment Outcome

This study aims to analyze the clinical significance of the measuring B-type natriuretic peptide (BNP) and stress glycemia in patients with acute coronary syndrome (ACS), and to investigate the relationships between the two biomarkers and the severity of coronary artery lesions. One hundred and five consecutive patients with ACS admitted for coronary artery angiography were divided into three clinical subgroups. These patients were then further assigned into either of three subgroups according to their Gensini score. Moreover, a group of patients with stable angina (SA) and those with no history of coronary disease served as controls. The patients' BNP levels were analyzed on admission and their fasting blood glucose was measured the next morning. BNP and fasting blood glucose concentrations were highly elevated in patients with ACS irrespective of their subgroups compared to SA and control patients. This observation was statistically significant (P < 0.001). Further, the concentrations of BNP and fasting blood glucose between the three ACS subgroups were significantly different (P < 0.001) depending on the severity of the coronary artery disease. There is a positive correlation between levels of BNP and blood glucose concentration and Gensini score in ACS patients (r = 0.782, P < 0.05, r = 0.732, P < 0.05). BNP level and stress glycemia were significantly higher in ACS patients than those in SA and control groups. There is a correlation between BNP level and stress blood glucose concentration and the severity of coronary artery lesions. Combined analysis of BNP and stress blood glucose can be helpful and effective for risk stratification of patients with ACS after admission.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Angina, Stable; Blood Glucose; Coronary Angiography; Coronary Artery Disease; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Stress, Physiological

Angina is chest pain induced by ischemia of the heart muscle, generally due to obstruction or spasm of the coronary arteries. People that suffer from average to severe cases of angina have an increased percentage of death before the age of 55, usually around 60%. Therefore, prevention of major complications, optimizing diagnosis, prognosis and therapeutics are of primary importance. The main objective of this study was to uncover biomarkers by comparing serum protein profiles of patients suffering from stable or unstable angina and controls. We identified by non-targeted proteomic approach and confirmed by the means of independent techniques, the differential expression of several proteins indicating significantly increased vascular inflammation response, disturbance in the lipid metabolism and in atherogenic plaques stability.

Topics: Aged; Aged, 80 and over; Angina, Stable; Angina, Unstable; Biomarkers; Blood Proteins; C-Reactive Protein; Case-Control Studies; Female; Humans; Lipid Metabolism; Lipids; Male; Middle Aged; Myocardial Ischemia; Natriuretic Peptide, Brain; Plaque, Atherosclerotic; Proteomics; Sensitivity and Specificity; Troponin

B-type natriuretic peptide (BNP) has been employed as a risk marker in patients with coronary artery disease (CAD) with ST elevation and non-ST elevation. It is not yet established if early BNP measurements provide additional information to troponin and electrocardiographic analysis in patients without ventricular enlargement and systolic dysfunction.. This study compared BNP levels in patients with stable angina (SA) and acute coronary syndromes with non-ST elevation in relation to angiographic lesions (NSTEMI-ACS). Moreover, the diagnostic utility of BNP was determined using the receiver operating characteristic curve.. 280 patients with CAD without ST elevation and preserved systolic function were studied. BNP samples were measured in all recruited patients within 24 hours of hospitalization.. BNP values increased progressively with the severity of diagnosis: SA (n = 85; 50.4 ± 50 pg/ml) NSTEMI-ACS (n = 195; 283 ± 269 pg/ml; p < 0.0001). The analysis of BNP in relation to the number of involved vessels demonstrated significantly increased levels in patients with multivessel disease compared to patients with 1- or 2-vessel disease (p < 0.001 and p < 0.003). Values of BNP >80 pg/ml were shown to be able to predict CAD severity and coronary vessel involvement (AUC = 0.80; p = 0.0001) with a sensitivity of 78% and a specificity of 72%. In multivariate analysis, BNP levels >80 pg/ml, CAD history, and ST deviation >2 mm were confirmed as independent predictors of CAD severity.. Circulating BNP levels appear elevated in NSTEMI-ACS, without left ventricular systolic dysfunction. A BNP cut-off value of 80 pg/ml is a good predictor of CAD extension.

Topics: Acute Coronary Syndrome; Aged; Angina, Stable; Biomarkers; Coronary Angiography; Coronary Disease; Female; Humans; Italy; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Risk Factors; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Systole; Up-Regulation; Ventricular Function, Left

High-sensitivity cardiac troponin (hs-TnT) and N-terminal probrain natriuretic peptide (NT-proBNP) are powerful predictors of mortality in patients with stable coronary artery disease. Whether their combined use may further improve mortality prediction in these patients is unknown.. The study included 869 patients with stable coronary artery disease who underwent percutaneous coronary intervention. Hs-TnT and NT-proBNP were measured before angiography. Using median values of hs-TnT (0·008 μg L(-1)) and NT-proBNP (250·0 ng L(-1)) as cut-off points, patients were divided into four groups: low hs-TnT/low NT-proBNP group (293 patients with hs-TnT and NT-proBNP < median); low hs-TnT/high NT-proBNP group (142 patients with hs-TnT < median and NT-proBNP ≥ median); high hs-TnT/low NT-proBNP group (142 patients with hs-TnT ≥ median and NT-proBNP < median) and high hs-TnT/high NT-proBNP group (292 patients with hs-TnT and NT-proBNP ≥ median). The primary end point was all-cause mortality.. The 4-year follow-up was complete in 90·7% of the patients. There were 76 deaths during the follow-up: seven in low hs-TnT/low NT-proBNP, 8 in low hs-TnT/high NT-proBNP, 10 in high hs-TnT/low NT-proBNP and 51 in high hs-TnT/high NT-proBNP groups (mortality estimates, 2·5%, 5·9%, 7·4% and 18·1%, respectively; odds ratio = 8·64, 95% confidence interval 3·85-19·4, P < 0·001 for high hs-TnT/high NT-proBNP vs. low hs-TnT/low NT-proBNP). Inclusion of hs-TnT and NT-proBNP in the multivariable model increased the discriminatory power of the model regarding mortality prediction compared with the model without biomarkers (absolute and relative integrated discrimination improvement 0·039 and 26·0%, P = 0·0015).. Combined use of hs-TnT and NT-proBNP improves long-term risk prediction of mortality in patients with stable coronary heart disease.

Topics: Aged; Angina, Stable; Biomarkers; Female; Humans; Linear Models; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Severity of Illness Index; Troponin