Elevated n-terminal pro-brain natriuretic peptide is associated with mortality in tobacco smokers independent of airflow obstruction

Background: Tobacco use is associated with an increased prevalence of cardiovascular disease. N-terminal pro-brain natiuretic peptide (NT-proBNP), a widely available biomarker that is associated with cardiovascular outcomes in other conditions, has not been investigated as a predictor of mortality in tobacco smokers. We hypothesized that NT-proBNP would be an independent prognostic marker in a cohort of well-characterized tobacco smokers without known cardiovascular disease. Methods: Clinical data from 796 subjects enrolled in two prospective tobacco exposed cohorts was assessed to determine factors associated with elevated NT-proBNP and the relationship of these factors and NT-proBNP with mortality. Results: Subjects were followed for a median of 562 (IQR 252 - 826) days. Characteristics associated with a NT-proBNP above the median (≥49 pg/mL) were increased age, female gender, and decreased body mass index. By time-to-event analysis, an NT-proBNP above the median (≥49 pg/mL) was a significant predictor of mortality (log rank p = 0.02). By proportional hazard analysis controlling for age, gender, cohort, and severity of airflow obstruction, an elevated NT-proBNP level (≥49 pg/mL) remained an independent predictor of mortality (HR = 2.19, 95% CI 1.07-4.46, p = 0.031). Conclusions: Elevated NT-proBNP is an independent predictor of mortality in tobacco smokers without known cardiovascular disease, conferring a 2.2 fold increased risk of death. Future studies should assess the ability of this biomarker to guide further diagnostic testing and to direct specific cardiovascular risk reduction inventions that may positively impact quality of life and survival. © 2011 Stamm et al

Parametric Response Mapping as an Imaging Biomarker in Lung Transplant Recipients

The predominant cause of chronic lung allograft failure is small airway obstruction arising from bronchiolitis obliterans. However, clinical methodologies for evaluating presence and degree of small airway disease are lacking.status: publishe

Systemic Sclerosis Associated Interstitial Lung Disease: A Conceptual Framework for Subclinical, Clinical, and Progressive Disease

OBJECTIVES: Establish a framework by which experts define disease subsets in systemic sclerosis associated interstitial lung disease (SSc-ILD). METHODS: A conceptual framework for subclinical, clinical, and progressive ILD was provided to eighty-three experts, asking them to use the framework and classify actual SSc-ILD patients. Each patient profile was designed to be classified by at least 4 experts in terms of severity and risk of progression at baseline; progression was based on 1-year follow-up data. A consensus was reached if ≥ 75% of experts agreed. Experts provided information on which items were important in determining classification. RESULTS: Forty-four experts (53%) completed the survey. Consensus was achieved on the dimensions of severity (75%, 60 of 80 profiles), risk of progression (71%, 57 of 80 profiles) and progressive ILD (60%, 24 of 40 profiles). For profiles achieving consensus, most were classified as clinical ILD (92%), low risk (54%), and stable (71%). Severity and disease progression overlapped in terms of framework items that were most influential in classifying patients (forced vital capacity, extent of lung involvement on high resolution chest CT (HRCT)); risk of progression was influenced primarily by disease duration. CONCLUSIONS: Using our proposed conceptual framework, international experts were able to achieve a consensus on classifying SSc-ILD patients along the dimensions of disease severity, risk of progression, and progression over time. Experts rely on similar items when classifying disease severity and progression: a combination of spirometry and gas exchange and quantitative HRCT

Measurement of CPCP violation in B0→D∗±D∓B^0\to D^{*\pm} D^{\mp} decays

International audienceThe decay-time-dependent CP asymmetry in B$^{0}$→ D$^{∗±}$D$^{∓}$ decays is mea- sured using a data set corresponding to an integrated luminosity of 9 fb$^{−1}$ recorded by the LHCb detector in proton-proton collisions at centre-of-mass energies of 7, 8 and 13 TeV. The CP parameters are measured as${\displaystyle \begin{array}{c}{S}_{D\ast D}=-0.861\pm 0.077\left(\mathrm{stat}\right)\pm 0.019\left(\mathrm{syst}\right),\\ {}\varDelta {S}_{D\ast D}=0.019\pm 0.075\left(\mathrm{stat}\right)\pm 0.012\left(\mathrm{syst}\right),\\ {}{C}_{D\ast D}=-0.059\pm 0.092\left(\mathrm{stat}\right)\pm 0.020\left(\mathrm{syst}\right),\\ {}{\varDelta C}_{D\ast D}=-0.031\pm 0.092\left(\mathrm{stat}\right)\pm 0.016\left(\mathrm{syst}\right),\\ {}{\mathcal{A}}_{D\ast D}=\kern0.75em 0.008\pm 0.014\left(\mathrm{stat}\right)\pm 0.006\left(\mathrm{syst}\right).\end{array}}$The analysis provides the most precise single measurement of CP violation in this decay channel to date. All parameters are consistent with their current world average values.[graphic not available: see fulltext