natriuretic-peptide--brain and Aortic-Aneurysm--Thoracic

Acute aortic dissection (AAD) is a life-threatening medical emergency that requires immediate diagnosis and rapid treatment. There is a paucity of data on the role of biomarkers in risk stratification of patients with AAD.. N-terminal pro-brain natriuretic peptide (NT-proBNP) is associated with short-term mortality in AAD patients.. We systematically searched Medline and Scopus to identify all observational cohort studies published before January 2020 that compared outcome (short-term mortality) in patients with AAD with high vs low levels of baseline NT-proBNP combining terms "brain natriuretic peptide" and "aortic dissection." A meta-analysis was conducted using the generic inverse variance method. Heterogeneity between studies was investigated using the Cochrane's Q test and I. Four studies were included in final analysis including a total of 950 patients, and 105 (11%) patients died. Baseline NT-proBNP concentrations were significantly higher in nonsurvivors (median 2240 pg/mL, range 1678-16 347 pg/mL) when compared to survivors (665 pg/mL, 328-1252 pg/mL). Elevated NT-proBNP values were significantly associated with an increased risk of short-term mortality (odds ratio 4.13, 95% CI [confidence interval] 2.33-7.33), with low heterogeneity (I. Elevated NT-proBNP levels on admission are associated with an increased risk of short-term mortality in AAD.

Topics: Acute Disease; Aortic Aneurysm, Thoracic; Aortic Dissection; Biomarkers; Global Health; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Protein Precursors; Risk Factors; Survival Rate

This retrospective study aimed to investigate the predictive value of biomarkers for in-hospital mortality of patients with Stanford type A acute aortic dissection (AAD).AAD is a life-threatening disease with an incidence of about 2.6-3.6 cases per 100,000/year.A total of 67 consecutive Stanford type A AAD patients admitted to hospital were divided into a deceased group and survival group. The baseline information of the patients between two groups was systematically compared, followed by examination of the electrocardiograms (ECG). Based on the follow-up during hospitalization, we investigated the simultaneous assessment of indexes like fragmented QRS complex (fQRS), admission systolic blood pressure (SBP), aortic diameter, surgical management, troponin I (TnI), white blood cell (WBC) count, N-terminal pro-brain natriuretic peptide (NT-proBNP), and D-dimer.The levels of TnI and NT-proBNP, WBC counts, and rate of fQRS (+) in patients of the deceased group were significantly higher than those in the survival group. The male sex (hazard ratio, 10.88; P = 0.001), admission SBP (hazard ratio, 0.98; P = 0.012), NT-proBNP (hazard ratio, 1.00; P = 0.001), and WBC count (hazard ratio, 1.10; P = 0.033) were independently related with in-hospital death. As a single marker, WBC count had the highest sensitivity at 84.6% (specificity 65.9%).Admission SBP, NT-proBNP, and WBC count were potential independent risk factors of in-hospital death in Stanford type A AAD patients. WBC count may be a more accurate predictor of type A AAD than either alone.

Topics: Adult; Aortic Aneurysm, Thoracic; Aortic Dissection; Biomarkers; Blood Pressure; China; Electrocardiography; Female; Fibrin Fibrinogen Degradation Products; Hospital Mortality; Humans; Leukocyte Count; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Factors; Troponin I

Afterload is considered to be an important factor regulating heart failure. Aortic structure or pathology may affect afterload to various extents. However, the contribution of aortic diseases, such as aortic aneurysm or aortic dissection, to heart failure status has not been completely elucidated.Here we describe a 78-year-old patient with severe heart failure who made a dramatic recovery from cardiac decompensation following endovascular thoracic aortic aneurysm surgery. He previously underwent graft replacement for impending rupture of the descending aorta and replacement of both the mitral valve and aortic valve to address valve regurgitation. Subsequently, his left ventricular (LV) function became severely depressed (13%) and serum brain natriuretic peptide (BNP) level remained high (approximately 880-3520 pg/mL). Conversely, his aortic arch was dilated to 70 mm and required surgical intervention. Despite his extremely high vascular surgery risk due to severely depressed cardiac function, stent grafting for thoracic aortic aneurysm was successfully performed. Furthermore, the severity of his depressed cardiac function and heart failure dramatically improved following stent grafting. The left ventricular ejection fraction improved from 13% presurgery to 55% postsurgery and the serum BNP level had significantly decreased to 70- 240 pg/mL. These improvements helped to alleviate the patient's heart failure symptoms, including shortness of breath.This case suggests a possible beneficial effect of aortic aneurysm repair for improving cardiac function and heart failure; our study presents a new concept of another extrinsic factor that can affect cardiac function through modulation of afterload.

Topics: Aged; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Postoperative Period; Severity of Illness Index; Stents; Stroke Volume; Treatment Outcome; Ventricular Dysfunction, Left

The purpose of this study was describe the cardiovascular phenotype of the aneurysms-osteoarthritis syndrome (AOS) and to provide clinical recommendations.. AOS, caused by pathogenic SMAD3 variants, is a recently described autosomal dominant syndrome characterized by aneurysms and arterial tortuosity in combination with osteoarthritis.. AOS patients in participating centers underwent extensive cardiovascular evaluation, including imaging, arterial stiffness measurements, and biochemical studies.. We included 44 AOS patients from 7 families with pathogenic SMAD3 variants (mean age: 42 ± 17 years). In 71%, an aortic root aneurysm was found. In 33%, aneurysms in other arteries in the thorax and abdomen were diagnosed, and in 48%, arterial tortuosity was diagnosed. In 16 patients, cerebrovascular imaging was performed, and cerebrovascular abnormalities were detected in 56% of them. Fifteen deaths occurred at a mean age of 54 ± 15 years. The main cause of death was aortic dissection (9 of 15; 60%), which occurred at mildly increased aortic diameters (range: 40 to 63 mm). Furthermore, cardiac abnormalities were diagnosed, such as congenital heart defects (6%), mitral valve abnormalities (51%), left ventricular hypertrophy (19%), and atrial fibrillation (22%). N-terminal brain natriuretic peptide (NT-proBNP) was significantly higher in AOS patients compared with matched controls (p < 0.001). Aortic pulse wave velocity was high-normal (9.2 ± 2.2 m/s), indicating increased aortic stiffness, which strongly correlated with NT-proBNP (r = 0.731, p = 0.005).. AOS predisposes patients to aggressive and widespread cardiovascular disease and is associated with high mortality. Dissections can occur at relatively mildly increased aortic diameters; therefore, early elective repair of the ascending aorta should be considered. Moreover, cerebrovascular abnormalities were encountered in most patients.

Topics: Adolescent; Adult; Aged; Aneurysm; Aortic Aneurysm, Thoracic; Aortic Dissection; Aortography; Cardiovascular Diseases; Cause of Death; Cerebrovascular Disorders; Chromosome Aberrations; Cohort Studies; Female; Genes, Dominant; Genomic Structural Variation; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Male; Middle Aged; Natriuretic Peptide, Brain; Osteoarthritis; Peptide Fragments; Phenotype; Pregnancy; Smad3 Protein; Survival Analysis; Syndrome; Vascular Stiffness; Young Adult

Acute Stanford type A aortic dissection (AAD) is associated with substantial perioperative mortality and morbidity.. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a prognostic biomarker of outcome in cardiovascular disease. Its predictive power in patients undergoing emergency surgery for acute type A aortic dissection is yet unknown.. We prospectively measured pre-operative NT-proBNP in 104 patients (39 female, 35%; median age 61 years) undergoing emergency surgery for AAD during a 6-year study period. European System for Cardiac Operative Risk Evaluation risk scores were recorded and patients were followed for 30-day mortality and major adverse events (MAEs) as defined by the need for rethoracotomy, occurrence of postoperative heart failure, neurologic deficit, lung failure, renal failure, or sepsis.. Median logistic European System for Cardiac Operative Risk Evaluation in the cohort was 12 (interquartile range 7 to 19). During the first 30 days, 23 patients (22%) died, and 53 patients (51%) experienced MAEs. Median (interquartile range) NT-proBNP levels in survivors versus nonsurvivors were 328 pg/ml (157 to 569) versus 2,240 pg/ml (515 to 4,734; p < 0.001), and in patients without versus with MAEs, 227 pg/ml (107 to 328) and 719 pg/ml (442 to 2,287; p < 0.001), respectively. Adjusted odds ratios for increasing tertiles of NT-proBNP compared with the lowest tertile were 0.98 (95% confidence interval [CI] 0.18 to 5.33; p = 0.98) and 11.67 (95% CI 2.61 to 52.09; p = 0.001) for 30-day mortality and 9.07 (95% CI 2.58 to 31.83; p = 0.001) and 50.21 (95% CI 10.85 to 232.45; p < 0.001) for MAEs, respectively, indicating a significant association between pre-operative NT-proBNP levels and outcome.. Pre-operative NT-proBNP predicts outcome in patients undergoing surgery of AAD.

Topics: Aged; Aortic Aneurysm, Thoracic; Aortic Dissection; Biomarkers; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Preoperative Care; Prospective Studies; Reoperation; Treatment Outcome