| 1. |
- Bjurman, Christian, 1983, et al.
(författare)
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Assessment of a multimarker strategy for prediction of mortality in older heart failure patients: a cohort study
- 2013
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 3:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Primarily to develop a multimarker score for prediction of 3-year mortality in older patients with decompensated heart failure (HF). DESIGN: Prospective cohort study. SETTING: Secondary care. Single centre. PATIENTS AND BIOMARKERS: 131 patients, aged >/=65 years, with decompensated HF were included. Assessment of biomarkers was performed at discharge. PRIMARY OUTCOME MEASURE: 3-year mortality. RESULTS: Mean age was 73+/-11 years; mean left ventricular ejection fraction , 43+/-14%; 53% were male. The 3-year mortality was 53.4%. The following N-terminal brain natriuretic peptide (NTproBNP) levels could optimally stratify mortality: <2000 ng/l (n=39), 30.8% mortality; 2000-8000 ng/l (n=58), 51.7% mortality; and >8000 ng/l (n=34), 82.4% mortality. However, in the 2000-8000 ng/l range, NTproBNP levels had low-prognostic capacity, based on the area under the receiver operating characteristic curve (AUC=0.53; 95% CI 0.40 to 0.67). In this group, multivariate analysis identified age, cystatin C (CysC), and troponin T (TnT) levels as independent risk factors. A risk score based on these three risk factors separated a high-risk and low-risk groups within the NTproBNP range of 2000-8000 ng/l. The score exhibited a significantly higher AUC (0.75; 95% CI 0.62 to 0.86) than NTproBNP alone (p=0.03) in this NTproBNP group and had similar prognostic capacity as NTproBNP in patients below or above this NTproBNP range (p=0.57). Net reclassification improvement and integrated discriminatory improvement in the group with NTproBNP levels between 2000 and 8000 ng/l was 54% and 23%, respectively, and in the whole cohort 22% and 11%, respectively. CONCLUSIONS: Our results suggested that, to assess risk in HF, older patients required significantly higher levels of NTproBNP than younger patients. Furthermore, a risk score that included TnT and CysC at discharge, and age could improve risk stratification for mortality in older patients with HF in particular when NTproBNP was moderately elevated.
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| 2. |
- Jensen, Juliana, 1965, et al.
(författare)
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Characteristics of heart failure in the elderly--a hospital cohort registry-based study.
- 2008
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Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 125:2, s. 191-6
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Tidskriftsartikel (refereegranskat)abstract
- Heart failure patient in the elderly is a growing population with poor prognosis. However this patient population has not been well studied. The present study is based on a hospital cohort heart failure registry during 2005 at Heart Failure Centre Medicine, Dept. of Medicine, SU/Sahlgrenska Hospital. In this study 150 patients were enrolled consecutively for analysis. They are aged around 80 years old with high comorbidity. One-year mortality is 30%. Multivariate analyses demonstrated that significant prognostic indicators for mortality are increasing age, New York Heart Association functional class and presence of comorbidities such as chronic obstructive pulmonary disease and renal failure. The use of aldosterone receptor antagonist is also associated with poor prognosis. Prescriptions of ACE inhibitor and beta-blockers are 57.5% and 73% respectively. Added-on therapy with angiotensin receptor 1 antagonist is few. In around 30% of prescriptions of ACE inhibitors daily dose is less than half of target dose. In around 54% of beta-blockers daily dose is less than half of target dose. There are clear potential for improved medications with guideline recommended agents in light of the fact that in these study patients 82% of heart rates is >60 beats/min, 84% of S-creatinine is <150 mmol/l, 17.4% of systolic blood pressure is 140-160 mmHg and 10% is 160-180 mmHg. CONCLUSIONS: This study provides an insight into the characteristics of a very old heart failure group with high comorbidity and mortality in a real situation. In agreement with previous studies, increasing age was associated with reduced likelihood of treatment particularly in ACE inhibitor and angiotensin receptor 1 blocker but this has been improved particularly in beta-blocker. There is a need to further improve education and application of guideline recommended medications for patients with heart failure for their well-being and survival.
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| 3. |
- Jensen, Juliana, 1965, et al.
(författare)
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Inflammation increases NT-proBNP and the NT-proBNP/BNP ratio.
- 2010
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Ingår i: Clinical research in cardiology : official journal of the German Cardiac Society. - : Springer Science and Business Media LLC. - 1861-0692. ; 99:7, s. 445-452
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Tidskriftsartikel (refereegranskat)abstract
- Plasma BNP and NT-proBNP are often regarded as interchangeable parameters in assessing heart failure (HF) severity and prognosis. Renal failure results in disproportionate increases of NT-proBNP and an increased NT-proBNP/BNP ratio. Low kidney function is therefore considered particularly when NT-proBNP is used to assess HF. The purpose of this study was to identify other conditions affecting the NT-proBNP/BNP ratio. We examined the NT-proBNP/BNP ratio, 26 other lab parameters, and clinical factors in 218 patients admitted to the HF ward. In addition to renal function, we also found significant correlations between the NT-proBNP/BNP ratio and inflammation as measured by orosomucoid (r = 0.525, p < 0.0001), CRP (r = 0.333, p < 0.0001), haptoglobulin (r = 0.201, p = 0.02), and alpha1-antitrypsin (r = 0.223, p = 0.01). Reverse correlation was found with transferrin (r = -0.323, p < 0.0001), albumin (r = -0.251, p = 0.003), and S-Fe (r = -0.205, p = 0.02), parameters known to decrease during inflammation. Inflammation increased levels of NT-proBNP more than BNP, resulting in an increased NT-proBNP/BNP ratio. Our findings indicate that NT-proBNP should be evaluated concomitantly with inflammatory status to avoid overestimation of HF severity.
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| 4. |
- Jensen, Juliana, 1965, et al.
(författare)
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Prognostic values of NTpro BNP/BNP ratio in comparison with NTpro BNP or BNP alone in elderly patients with chronic heart failure in a 2-year follow up.
- 2012
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Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 155:1, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Plasma BNP and NT-proBNP are often used as interchangeable parameters in heart failure care in clinical practice. In our previous study we have shown that inflammation was able to induce increased NT pro BNP in a hospital cohort with chronic heart failure in the elderly, indicating that NT-proBNP/BNP ratio should be evaluated concomitantly with inflammatory status to avoid overestimation of heart failure severity. The present study was aimed to evaluate the clinical significance of NT-proBNP/BNP ratio in comparison with NTpro BNP or BNP alone as a prognostic indicator in a 2-year follow up of elderly heart failure population. MATERIALS AND METHODS: One hundred and eight-nine elderly heart failure patients (72±11years, male 52%, LVEF 46±14%) were enrolled consecutively during 2006 and 2007 and followed up during 2years. NTpro BNP and BNP were measured routinely. RESULTS: We have found that NTpro BNP/BNP ratio provides no additional prognostic information during follow up as compared to NTpro BNP or BNP alone in an elderly population with chronic heart failure. By the use of ROC curves, for total mortality predictive accuracy during 2years, the cut-off values are NTproBNP≥800pg/ml, BNP>60pg/ml and NTpro BNP/BNP ratio>6.4 respectively. In terms of NTpro BNP, as long as its serum level is above 2000pg/ml it indicates poor prognosis. However there is an overlap between serum concentration range 2000-8000pg/ml and >8000pg/ml in terms of prognostic indicator. Similarly for BNP, as long as its serum level is above 100pg/ml, it indicates poor prognosis. However there is an overlap between serum concentration range 100-800pg/ml and >800pg/ml in terms of prognostic indicator. There was significant correlation between survival and NTpro BNP, BNP and Cystatin-C but not with NTpro BNP/BNP ratio. Such correlation exists irrespective of subgroups regardless of less than or older than 70years old. CONCLUSIONS: Our results demonstrated that in elderly heart failure population NTpro BNP/BNP ratio may provide diagnostic help in the presence of acute infection but no additional prognostic information in the long run as compared with NTpro BNP or BNP alone. Furthermore, both NTpro BNP and BNP are useful prognostic biomarkers indeed but they need to be interpreted with caution when it is used as a single biomarker and in the meantime concomitant diseases exist because patients may die due to non-cardiac causes.
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