natriuretic-peptide--brain and Carotid-Artery-Diseases

In patients with psoriatic disease (PsD), we determined whether cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were associated with carotid plaque burden and the development of cardiovascular events independent of the Framingham Risk Score (FRS).. Among 1,000 patients with PsD, carotid total plaque area (TPA) was measured in 358 participants at baseline. Cardiac troponin I and NT-proBNP were measured using automated clinical assays. The association between cardiac biomarkers and carotid atherosclerosis was assessed by multivariable regression after adjusting for cardiovascular risk factors. Improvement in the prediction of cardiovascular events beyond the FRS was tested using measures of risk discrimination and reclassification.. In univariate analyses, cTnI (β coefficient 0.52 [95% confidence interval (95% CI) 0.3, 0.74], P < 0.001) and NT-proBNP (β coefficient 0.24 [95% CI 0.1, 0.39], P < 0.001) were associated with TPA. After adjusting for cardiovascular risk factors, the association remained statistically significant for cTnI (adjusted β coefficient 0.21 [95% CI 0, 0.41], P = 0.047) but not for NT-proBNP (P = 0.21). Among the 1,000 patients with PsD assessed for cardiovascular risk prediction, 64 patients had incident cardiovascular events. When comparing a base model (with the FRS alone) to expanded models (with the FRS plus cardiac biomarkers), there was no improvement in predictive performance.. In patients with PsD, cTnI may reflect the burden of atherosclerosis, independent of traditional cardiovascular risk factors. Cardiac troponin I and NT-proBNP are associated with incident cardiovascular events independent of the FRS, but further study of their role in cardiovascular risk stratification is warranted.

Topics: Arthritis, Psoriatic; Biomarkers; Carotid Artery Diseases; Cohort Studies; Humans; Longitudinal Studies; Natriuretic Peptide, Brain; Peptide Fragments; Plaque, Atherosclerotic; Prognosis; Psoriasis; Risk Assessment; Risk Factors; Troponin I

Atrial fibrillation (AF) is a major cause of cardio-embolism in patients with stroke and transient ischemic attack (TIA). Insertable cardiac monitors (ICM) make long-term monitoring for AF possible, but limited health care resources make patient selection important. AF is associated with atherosclerosis and markers of this could potentially be used to guide AF monitoring.. One-hundred fourteen TIA-patients without AF were thoroughly monitored for AF with ECG, 72-hour Holter monitoring and ICM with a median monitoring time of 2.2 years. Patients with AF (n = 18) were significantly older than patients without AF (age 71.1 versus 64.4 years, P = .008) but were otherwise similar in regards to comorbidities. AF patients had significantly thicker carotid intima-media and also more often presence of carotid plaques than patients without AF, but no difference was found after adjusting for age and sex. No difference in noncontrast cardiac CT calculated coronary artery calcium score was found between the 2 groups. Serum biomarkers did not differ between groups, except for brain natriuretic peptide (BNP), where patients with BNP in the upper tertile were more likely to have AF than patients with BNP in the lowest tertile, odds ratio 5.96 (95% confidence interval 1.04-34.07, P = .045).. Carotid intima-media thickness and coronary artery calcium score were poor predictors of AF in patients with TIA. Apart from BNP, the examined biomarkers (hs-CRP, MR-proADM, c-TnI, copeptin) had no predictive value, but larger scale studies are needed to confirm these findings.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Biomarkers; Carotid Artery Diseases; Carotid Intima-Media Thickness; Coronary Angiography; Coronary Artery Disease; Denmark; Electrocardiography, Ambulatory; Female; Humans; Incidence; Ischemic Attack, Transient; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Remote Sensing Technology; Risk Factors; Signal Processing, Computer-Assisted; Vascular Calcification; Young Adult

Approximately one-sixth of all ischemic strokes are attributable to embolic stroke of undetermined source (ESUS). Recent analyses suggest that atrial cardiopathy and nonstenotic carotid plaque (nsCP) may represent 2 distinct underlying causes in patients with ESUS, although both diseases share common risk factors and are pathophysiologically intertwined. In this study, we, therefore, aimed to search for associations between nsCP and markers of atrial remodeling and function in patients with embolic stroke.. Sixty-eight patients with ESUS or atrial fibrillation (AF)-related stroke proven by imaging who underwent comprehensive echocardiographic studies, including measurements of left atrial function and remodeling, were considered. Patients with ESUS underwent a follow-up of at least 1 year after index stroke. For 20 patients with ESUS, NT-proBNP (N-terminal pro-B-type natriuretic peptide) values were available. Presence of nsCP was evaluated considering Duplex sonography and computed tomography angiography and was further categorized in possibly or probably symptomatic nsCP.. ESUS patients with nsCP tended to have higher values of septal and lateral total atrial conduction times (. Presence of nsCP is associated with AF and markers of left atrial disease in patients with embolic stroke. Therefore, a thorough evaluation regarding atrial cardiopathy and AF in patients with ESUS should not be restricted if nsCP are found, even if high-risk plaque characteristics are evident.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Remodeling; Carotid Artery Diseases; Cerebral Angiography; Computed Tomography Angiography; Echocardiography; Embolic Stroke; Female; Heart Atria; Heart Conduction System; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Organ Size; Peptide Fragments; Plaque, Atherosclerotic; Ultrasonography

Pathologies in the heart-brain axis might, independently or in combination, accelerate the process of brain parenchymal loss. We aimed to investigate the association of serum N-terminal brain natriuretic peptide (NT-proBNP), as a marker of cardiac dysfunction, and carotid intima media thickness (CIMT), as a marker of carotid atherosclerosis burden, with structural brain changes.. In the longitudinal population-based AGES-Reykjavik study (Age, Gene/Environment Susceptibility-Reykjavik), we included 2430 subjects (mean age, 74.6 years; 41.4% men) with baseline data on NT-proBNP and CITM (assessed by ultrasound imaging). Participants underwent a high-resolution brain magnetic resonance imaging at baseline and 5 years later to assess total brain (TBV), gray matter, and white matter volumes. Each unit higher log-transformed NT-proBNP was associated with 3.6 mL (95% confidence interval [CI], -6.0 to -1.1) decline in TBV and 3.5 mL (95% CI, -5.7 to -1.3) decline in gray matter volume. Likewise, each millimeter higher CIMT was associated with 10.8 mL (95% CI, -17.3 to -4.2) decline in TBV and 8.6 mL (95% CI, -14.4 to -2.8) decline in gray matter volume. There was no association between NT-proBNP and CIMT and changes in white matter volume. Compared with participants with low NT-proBNP and CIMT, participants with both high NT-proBNP and CIMT had 3.8 mL (95% CI, -6.0 to -1.6) greater decline in their TBV and 4 mL (95% CI, -6.0 to -2.0) greater decline in GMW. These associations were independent of sociodemographic and cardiovascular factors.. Older subjects with both cardiac dysfunction and carotid atherosclerosis are at an increased risk for brain parenchymal loss. Accumulated pathologies in the heart-brain axis might accelerate brain atrophy.

Topics: Age Factors; Aged; Atrophy; Biomarkers; Brain; Carotid Artery Diseases; Carotid Intima-Media Thickness; Female; Gene-Environment Interaction; Genetic Predisposition to Disease; Heart Diseases; Humans; Iceland; Leukoencephalopathies; Longitudinal Studies; Magnetic Resonance Imaging; Male; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Time Factors

SSc is associated with an increased prevalence of atherosclerosis (ATS). This study assessed the prevalence of subclinical ATS as measured by carotid US and explored serum proteins to identify potential biomarkers of SSc-ATS.. Forty-six SSc female patients and 46 age- and ethnicity-matched controls underwent carotid US to assess the presence of plaque and carotid intima media thickness (CIMT). Abstracted data included demographics, ATS risk factors and serum measurements [cholesterol, proinflammatory high-density lipoprotein (piHDL), CRP, lipoproteins]. Serum cytokines/proteins analyses included circulating type I IFN activity by quantifying IFN-inducible genes, soluble junctional adhesion molecule A (sJAM-A) and 100 serum proteins by using a microplate-based multiplex platform. Proteins significant at P < 0.05 on bivariate analyses for the presence of plaque were used to develop a composite measure.. Patients with SSc had more plaque (45.6% vs 19.5%, P = 0.01) but similar CIMT compared with controls. Multiplex analysis detected significant associations between serum proteins of inflammation, vasculopathy and fibrosis with ATS in SSc, including IL-2, IL-6, CRP, keratinocyte growth factor, intercellular adhesion molecule 1, endoglin, plasminogen activator inhibitor 1 and insulin-like growth factor binding protein 3 associated with carotid plaque. Myeloid progenitor inhibitory factor 1, serum amyloid A, thrombomodulin, N-terminal pro-brain natriuretic peptide (BNP), and Clara cell secretory protein 16 kD correlated with CIMT. The median composite score for the plaque group was 6 and for the no plaque group it was 2 (P < 0.0001).. Patients with SSc have a higher prevalence of carotid plaque than matched controls, and patients with SSc-plaque vs patients without plaque have elevated serum proteins implicated in both vasculopathy and fibrosis. Further studies are needed to evaluate the role of these proteins in SSc compared with healthy controls.

Topics: Adult; Antigens, CD; Asymptomatic Diseases; Biomarkers; C-Reactive Protein; Carotid Arteries; Carotid Artery Diseases; Carotid Intima-Media Thickness; Case-Control Studies; Chemokines, CC; Cross-Sectional Studies; Endoglin; Female; Fibroblast Growth Factor 7; Humans; Insulin-Like Growth Factor Binding Protein 3; Intercellular Adhesion Molecule-1; Interleukin-2; Interleukin-6; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Plaque, Atherosclerotic; Plasminogen Activator Inhibitor 1; Receptors, Cell Surface; Risk Factors; Scleroderma, Systemic; Serum Amyloid A Protein; Thrombomodulin; Uteroglobin

Although brain natriuretic peptide (BNP) concentration has been associated with atherosclerosis and ischemic cardiovascular diseases (CVD) in the general population, less is known about this relationship in pre-dialysis chronic kidney disease (CKD) patients.. We prospectively analyzed 227 pre-dialysis patients with CKD [median estimated glomerular filtration rate (eGFR): 28.82 (11.65-48.20) ml/min/1.73 m(2)]. At enrollment, BNP concentrations, biochemical and echocardiographic parameters were measured, and carotid artery ultrasound was performed. Patients were prospectively followed for a mean 31.8 months (range 0.5-57.0 months). Ischemic CV events and patient outcomes were recorded.. Median BNP concentration at enrollment was significantly higher in the CKD patients than in a control group [53.9 (16.2-181.0) pg/ml vs. 9.4 (7.0-15.3) pg/ml, P<0.01]. BNP concentration was positively related with the carotid intima-media thickness of the common carotid artery (CCA-IMT) and left ventricular mass index (LVMI) and was significantly higher in patients with than without carotid plaques (P<0.01). Logistic regression analysis confirmed that lgBNP concentration was independently correlated with carotid plaques. Thirty-two patients experienced ischemic cardiovascular (ICV) events during follow-up. Kaplan-Meier analysis showed that cumulative survival without new ICV events was better in patients with lower than with higher BNP concentrations (P<0.01). Cox regression analysis showed that BNP was an independent risk factor for ICV events (HR=3.167, 95%CI=1.398-7.171, P<0.01).. Similar to findings in the general population, elevated BNP level is related to atherosclerosis and an increased risk of ICV events in pre-dialytic CKD patients.

Topics: Adult; Aged; Atherosclerosis; Cardiovascular Diseases; Carotid Artery Diseases; Carotid Artery, Common; Carotid Intima-Media Thickness; Case-Control Studies; Cross-Sectional Studies; Female; Humans; Longitudinal Studies; Male; Middle Aged; Myocardial Ischemia; Natriuretic Peptide, Brain; Plaque, Atherosclerotic; Prognosis; Prospective Studies; Renal Insufficiency, Chronic; Risk Factors

Arterial stiffness is an independent predictor of cardiovascular morbidity and mortality. Brain natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hs-CRP) are considered as novel biomarkers that are useful in the prediction of early cardiovascular risk. We studied the relationship between carotid artery stiffness index beta and the cardiovascular biomarkers BNP and hs-CRP in 55 consecutive subjects. Carotid artery stiffness was assessed using the stiffness index beta derived from brachial artery blood pressure measurement and carotid ultrasonography. Venous blood samples were obtained for BNP and hs-CRP. Pearson's correlation coefficient suggested a strong bivariate relationship between carotid stiffness index beta and age (r=0.56, P<0.0001), BNP (r=0.45, P<0.004) and hs-CRP (r=0.26, P=0.06), respectively. On multiple regression analysis, significant correlations were found between carotid stiffness index beta and age (P=0.004), BNP (P=0.027) and hs-CRP (P=0.029). These findings suggest that there is a relationship between intra-cardiac pressures (measured by BNP), vascular inflammation (measured by hs-CRP) and vascular stiffness. Cardiovascular biomarkers are thus associated with functional parameters of the vascular tree.

Topics: Adult; Biomarkers; Brachial Artery; C-Reactive Protein; Carotid Artery Diseases; Female; Humans; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Predictive Value of Tests; Regression Analysis; Risk Factors; Ultrasonography

While arterial stiffness is known to be related to atherosclerosis, the association between arterial stiffness and cardiac systolic and diastolic function in hypertension has not been fully evaluated. The present study was conducted to simultaneously evaluate the relationship of brachial-ankle pulse wave velocity (PWV) to parameters reflecting atherosclerosis and to those reflecting the risk of congestive heart failure in patients with hypertension. In 147 patients with hypertension, the left ventricular ejection fraction, the ratio of the peak velocity of early rapid filling and the peak velocity of atrial filling (E/A ratio), and left ventricular mass index were obtained from echocardiographs, the intima-media thickness of the common carotid artery was obtained by ultrasonography, the plasma B-type natriuretic peptide (BNP) level was measured by radioimmunoassay, and the brachial-ankle PWV was measured by the volume rendering method. Brachial-ankle PWV correlated positively with the intima-media thickness of the carotid artery, E/A ratio and BNP. Multiple linear regression analysis demonstrated that the relationship between the brachial-ankle PWV and the E/A ratio was significantly independent from other clinical variables. The receiver operator characteristic curve demonstrated that a brachial-ankle PWV of 1,600 cm/s was useful to discriminate mild cardiac diastolic dysfunction (E/A ratio of < or =0.75) (sensitivity=78% and specificity=58%). The present study demonstrated that increased brachial-ankle PWV relates not only to the parameters reflecting atherosclerosis but also to those reflecting cardiac diastolic dysfunction. Therefore, increased arterial stiffness is a possible simultaneous risk for atherosclerotic cardiovascular disease and diastolic heart failure in patients with hypertension.

Topics: Aged; Ankle; Blood Flow Velocity; Brachial Artery; Carotid Artery Diseases; Diastole; Female; Heart Failure; Humans; Hypertension; Linear Models; Male; Middle Aged; Natriuretic Peptide, Brain; Pulsatile Flow; Risk Factors; Systole; Ultrasonography; Ventricular Dysfunction, Left

Topics: Angioplasty, Balloon, Coronary; Atrial Natriuretic Factor; C-Reactive Protein; Carotid Artery Diseases; Clinical Trials as Topic; Combined Modality Therapy; Coronary Disease; Electrocardiography; Heart Failure; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Inflammation; Myocardial Revascularization; Natriuretic Peptide, Brain; Stents