| 1. |
- Dahlström, Ulf, et al.
(författare)
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Integration of B-type natiuretic peptide in heart failure outpatient programs.
- 2008
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Ingår i: Congestive Heart Failure. - : Wiley. - 1527-5299 .- 1751-7133. ; :14, s. 9-11
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Tidskriftsartikel (refereegranskat)abstract
- In many European countries, patients with heart failure (HF) are treated according to specific management programs. The key players are the HF cardiologists and the HF nurses, and they are supported by a number of other important players. The objectives of the HF team are to help verify the diagnosis, optimize treatment, and inform and educate the patients and their relatives to achieve beneficial effects in terms of improved survival, less hospitalization, and improved quality of life. The use of natriuretic peptides (NPs) helps the referring physician correctly diagnose and select patients for further investigations. Based on the levels of NPs, it is possible to risk-stratify patients and offer them individualized, tailored treatment. The present paper discusses and exemplifies how NP assessment may be integrated into an HF outpatient program. Our conclusion is that NP values will continue to be important and necessary tools in the routine management of patients with HF
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| 2. |
- Elliott, Perry, et al.
(författare)
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Development, validation and implementation of biomarker testing in cardiovascular medicine state-of-the-art : Proceedings of the European Society of Cardiology - Cardiovascular Round Table
- 2021
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Ingår i: Cardiovascular Research. - : Oxford University Press. - 0008-6363 .- 1755-3245. ; 117:5, s. 1248-1256
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Tidskriftsartikel (refereegranskat)abstract
- Many biomarkers that could be used to assess ejection fraction, heart failure, or myocardial infarction fail to translate into clinical practice because they lack essential performance characteristics or fail to meet regulatory standards for approval. Despite their potential, new technologies have added to the complexities of successful translation into clinical practice. Biomarker discovery and implementation requires a standardised approach that includes: identification of a clinical need; identification of a valid surrogate biomarker; stepwise assay refinement, demonstration of superiority over current standard-of-care; development and understanding of a clinical pathway; and demonstration of real-world performance. Successful biomarkers should improve efficacy or safety of treatment, while being practical at a realistic cost. Everyone involved in cardiovascular healthcare, including researchers, clinicians, and industry partners, are important stakeholders in facilitating the development and implementation of biomarkers. This paper provides suggestions for a development pathway for new biomarkers, discusses regulatory issues and challenges, and suggestions for accelerating the pathway to improve patient outcomes. Real life examples of successful biomarkers-high sensitivity cardiac troponin (hs-cTn), T2* cardiovascular magnetic resonance (CMR) imaging, and echocardiography-are used to illustrate the value of a standardised development pathway in the translation of concepts into routine clinical practice.
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| 3. |
- Maisel, Alan, et al.
(författare)
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Effect of Spironolactone on 30-Day Death and Heart Failure Rehospitalization (from the COACH Study)
- 2014
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Ingår i: American Journal of Cardiology. - : Elsevier. - 0002-9149 .- 1879-1913. ; 114:5, s. 737-742
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Tidskriftsartikel (refereegranskat)abstract
- The aim of our study is to investigate the effect of spironolactone on 30-day outcomes in patients with acute heart failure (AHF) and the association between treatment and outcomes stratified by biomarkers. We conducted a secondary analysis of the biomarker substudy of the multicenter COACH (Co-ordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure) trial involving 534 AHF patients for 30-day mortality and HF rehospitalizations. Spironolactone therapy was initiated and terminated at the discretion of the treating physician; 30-day outcomes were compared between patients who were treated with spironolactone and those who were not. Outcomes with spironolactone therapy. were explored based on N-terminal pro-B-type natriuretic peptide, ST2, galectin-3, and creatinine levels. Spironolactone was prescribed to 297 (55.6%) patients at discharge (158 new and 139 continued). There were 19 deaths and 30 HF rehospitalizations among 46 patients by 30 days. Patients discharged on spironolactone had significantly less 30-day event (hazard ratio 0.538, p = 0.039) after adjustment for multiple risk factors. Initiation of spironolactone in patients who were not on spironolactone before admission was associated with a significant reduction in event rate (hazard ratio 0.362, p = 0.027). The survival benefit of spironolactone was more prominent in patient groups with elevations of creatinine, N-terminal pro B-type natriuretic peptide, ST2, or galectin-3. In conclusion, AHF patients who received spironolactone during hospitalization had significantly fewer 30-day mortality and HF rehospitalizations, especially in high-risk patients.
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| 4. |
- Maisel, Alan, et al.
(författare)
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State of the art : Using natriuretic peptide levels in clinical practice
- 2008
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 10:9, s. 824-839
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Tidskriftsartikel (refereegranskat)abstract
- Natriuretic peptide (NP) levels (B-type natriuretic peptide (BNP) and N-terminal proBNP) are now widely used in clinical practice and cardiovascular research throughout the world and have been incorporated into most national and international cardiovascular guidelines for heart failure. The role of NP levels in state-of-the-art clinical practice is evolving rapidly. This paper reviews and highlights ten key messages to clinicians:•NP levels are quantitative plasma biomarkers of heart failure (HF).•NP levels are accurate in the diagnosis of HF.•NP levels may help risk stratify emergency department (ED) patients with regard to the need for hospital admission or direct ED discharge.•NP levels help improve patient management and reduce total treatment costs in patients with acute dyspnoea.•NP levels at the time of admission are powerful predictors of outcome in predicting death and re-hospitalisation in HF patients.•NP levels at discharge aid in risk stratification of the HF patient.•NP-guided therapy may improve morbidity and/or mortality in chronic HF.•The combination of NP levels together with symptoms, signs and weight gain assists in the assessment of clinical decompensation in HF.•NP levels can accelerate accurate diagnosis of heart failure presenting in primary care.•NP levels may be helpful to screen for asymptomatic left ventricular dysfunction in high-risk patients.
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| 5. |
- Marino, Rossella, et al.
(författare)
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Diagnostic and short-term prognostic utility of plasma pro-enkephalin (pro-ENK) for acute kidney injury in patients admitted with sepsis in the emergency department
- 2015
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Ingår i: Journal of Nephrology. - : Springer Science and Business Media LLC. - 1724-6059 .- 1121-8428. ; 28:6, s. 717-724
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Tidskriftsartikel (refereegranskat)abstract
- Background Acute kidney injury (AKI) aggravates the prognosis of patients with sepsis. Reliable biomarkers for early detection of AKI in this setting are lacking. Enkephalins influence kidney function, and may have a role in AKI from sepsis. We utilized a novel immunoassay for plasma proenkephalin (pro-ENK), a stable surrogate marker for endogenous enkephalins, in patients hospitalized with sepsis, in order to assess its clinical utility. Methods In an observational retrospective study we enrolled 101 consecutive patients admitted to the emergency department (ED) with suspected sepsis. Plasma levels of pro-ENK and neutrophil gelatinase-associated lipocalin (NGAL) were evaluated at ED arrival for their association with presence and severity of AKI and 7-day mortality. Results pro-ENK was inversely correlated to creatinine clearance (r = -0.72) and increased with severity of AKI as determined by RIFLE (risk, injury, failure, loss of function, end-stage renal disease) stages (p < 0.0001; pro-ENK median [interquartile range, IQR]) pmol/l: no AKI: 71 [41-97]; risk: 72 [51-120]; injury: 200 [104-259]; failure: 230 [104-670]; loss of function: 947 [273-811]. The majority of septic patients without AKI or at risk had pro-ENK concentrations within the normal range. While NGAL was similarly associated with AKI severity, it was strongly elevated already in septic patients without AKI. pro-ENK added predictive information to NGAL for detecting kidney dysfunction (added chi(2) 10.0, p = 0.0016). Admission pro-ENK outperformed creatinine clearance in predicting 7-day mortality (pro-ENK: chi(2) 13.4, p < 0.001, area under curve, AUC 0.69; creatinine clearance: chi(2) 4, p = 0.045, AUC: 0.61), and serial measurement improved prediction. Conclusions Use of pro-ENK in septic patients can detect the presence and severity of AKI. Moreover, pro-ENK is highly predictive of short-term mortality and could enable early identification of patients at risk of death.
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| 6. |
- McDonald, Ken, et al.
(författare)
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B-type natriuretic peptide: application in the community.
- 2008
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Ingår i: Congestive Heart Failure. - : Wiley. - 1527-5299 .- 1751-7133. ; :14, s. 12-16
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Tidskriftsartikel (refereegranskat)abstract
- Natriuretic peptide assessment has represented a significant advance in the management of heart failure. In a syndrome in which clinical symptoms and signs can be either nonspecific or absent, the presence of a reliable biomarker to aid diagnosis, assess prognosis, and potentially guide treatment and aid in prevention of this syndrome has represented a significant advance. The following review will outline established and potential new roles for natriuretic peptide assessment in the community
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| 7. |
- Meijers, Wouter C., et al.
(författare)
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Biomarkers and low risk in heart failure. Data from COACH and TRIUMPH
- 2015
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Ingår i: European Journal of Heart Failure. - : WILEY-BLACKWELL. - 1388-9842 .- 1879-0844. ; 17:12, s. 1271-1282
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Tidskriftsartikel (refereegranskat)abstract
- AimTraditionally, risk stratification in heart failure (HF) emphasizes assessment of high risk. We aimed to determine if biomarkers could identify patients with HF at low risk for death or HF rehospitalization. Methods and resultsThis analysis was a substudy of The Coordinating Study Evaluating Outcomes of Advising and Counselling in Heart Failure (COACH) trial. Enrolment of HF patients occurred before discharge. We defined low risk as the absence of death and/or HF rehospitalizations at 180days. We tested a diverse group of 29 biomarkers on top of a clinical risk model, with and without N-terminal pro-B-type natriuretic peptide (NT-proBNP), and defined the low risk biomarker cut-off at the 10th percentile associated with high positive predictive value. The best performing biomarkers together with NT-proBNP and cardiac troponin I (cTnI) were re-evaluated in a validation cohort of 285 HF patients. Of 592 eligible COACH patients, the mean (SD) age was 71 (+/- 11) years and median (IQR) NT-proBNP was 2521 (1301-5634) pg/mL. Logistic regression analysis showed that only galectin-3, fully adjusted, was significantly associated with the absence of events at 180days (OR 8.1, 95% confidence interval 1.06-50.0, P=0.039). Galectin-3, showed incremental value when added to the clinical risk model without NT-proBNP (increase in area under the curve from 0.712 to 0.745, P=0.04). However, no biomarker showed significant improvement by net reclassification improvement on top of the clinical risk model, with or without NT-proBNP. We confirmed our results regarding galectin-3, NT-proBNP, and cTnI in the independent validation cohort. Conclusion We describe the value of various biomarkers to define low risk, and demonstrate that galectin-3 identifies HF patients at (very) low risk for 30-day and 180-day mortality and HF rehospitalizations after an episode of acute HF. Such patients might be safely discharged.
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| 8. |
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| 9. |
- Melander, Olle, et al.
(författare)
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Validation of plasma proneurotensin as a novel biomarker for the prediction of incident breast cancer.
- 2014
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Ingår i: Cancer Epidemiology Biomarkers & Prevention. - 1538-7755. ; 23:8, s. 1672-1676
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Tidskriftsartikel (refereegranskat)abstract
- Background: High fasting plasma proneurotensin concentration was associated with the development of breast cancer in the Malmö Diet and Cancer Study (MDCS). Here we aimed at replicating the initial finding in an independent second cohort. Methods: The Malmö Preventive Project (MPP) is a population study and comprised 18 240 subjects when examined 2002-2006. Of women without history of breast cancer at examination, we included all who developed breast cancer during follow-up (n=130) until December 31st 2010 and a random sample of women without breast cancer until end of follow-up (n=1439) for baseline plasma proneurotensin assessment (mean age 70.0±4.4 years). Proneurotensin was measured in fasted plasma samples and was related to the risk of later breast cancer development using multivariate logistic regression. Results: Proneurotensin (odds ratio [OR] per SD increment of log-transformed proneurotensin) was significantly related to incident breast cancer (OR, 2.09; 95% CI, 1.79-2.44; P < 0.001; adjusted for age, BMI, smoking and hormone replacement therapy). The effect estimate in MPP was larger than in the discovery cohort (MDCS) with the main difference between the two cohorts being that women of the MPP study were on the average about 10 years older and follow-up time shorter compared to the MDCS. Conclusion: As initially found in the MDCS, fasting plasma proneurotensin was significantly associated with the development of breast cancer also in the MPP study. Impact: Measurement of plasma proneurotensin warrants further investigation as a blood based marker for early breast cancer detection.
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| 10. |
- Ståhlberg, Marcus, et al.
(författare)
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Post-Covid-19 Tachycardia Syndrome : A distinct phenotype of Post-acute Covid-19 Syndrome
- 2021
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Ingår i: The American journal of medicine. - : Elsevier BV. - 0002-9343 .- 1555-7162. ; 134:12, s. 1451-1456
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Forskningsöversikt (refereegranskat)abstract
- In this paper we highlight the presence of tachycardia in Post-acute Covid-19 Syndrome by introducing a new label for this phenomenon: Post-covid-19 tachycardia syndrome and argue that this constitutes a phenotype or sub-syndrome in PACS. We also discuss epidemiology, putative mechanisms, treatment options and future research directions in this novel clinical syndrome.
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