5 research outputs found
State of the art of immunoassay methods for B-type natriuretic peptides: An update
The aim of this review article is to give an update on the state of the art of the immunoassay
methods for the measurement of B-type natriuretic peptide (BNP) and its related peptides.
Using chromatographic procedures, several studies reported an increasing number of
circulating peptides related to BNP in human plasma of patients with heart failure. These
peptides may have reduced or even no biological activity. Furthermore, other studies have
suggested that, using immunoassays that are considered specific for BNP, the precursor of the
peptide hormone, proBNP, constitutes a major portion of the peptide measured in plasma of
patients with heart failure. Because BNP immunoassay methods show large (up to 50%)
systematic differences in values, the use of identical decision values for all immunoassay
methods, as suggested by the most recent international guidelines, seems unreasonable. Since
proBNP significantly cross-reacts with all commercial immunoassay methods considered
specific for BNP, manufacturers should test and clearly declare the degree of cross-reactivity of
glycosylated and non-glycosylated proBNP in their BNP immunoassay methods. Clinicians
should take into account that there are large systematic differences between methods when
they compare results from different laboratories that use different BNP immunoassays. On the
other hand, clinical laboratories should take part in external quality assessment (EQA) programs
to evaluate the bias of their method in comparison to other BNP methods. Finally, the authors
believe that the development of more specific methods for the active peptide, BNP1–32, should
reduce the systematic differences between methods and result in better harmonization of
results
Empower Workers to Innovate and Entrepreneurship: Raison D''tre of Successful Workers Cooperatives
Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH)
Objective To determine the effect of exercise training on survival in patients with heart failure due to left ventricular systolic dysfunction. Design Collaborative meta-analysis. Inclusion criteria Randomised parallel group controlled trials of exercise training, for at least eight weeks with individual patient data on survival for at least three months. Studies reviewed Nine datasets, totalling 801 patients: 395 received exercise training and 406 were controls. Main outcome measure Death from all causes. Results During a mean (SD) follow up of 705 (729) days there were 88 (22%) deaths in the exercise arm and 105 (26%) in the control arm. Exercise training significantly reduced mortality (hazard ratio 0.65, 95% confidence interval, 0.46 to 0.92; log rank chi(2) = 5.9; P = 0.015). The secondary end point of death or admission to hospital was also reduced (0.72, 0.56 to 0.93; log rank chi(2) = 6.4; P = 0.011). No statistically significant subgroup specific treatment effect was observed. Conclusion Meta-analysis of randomised trials to date gives no evidence that properly supervised medical training programmes for patients with heart failure might be dangerous, and indeed there is clear evidence of an overall reduction in mortality. Further research should focus on optimising exercise programmes and identifying appropriate patient groups to target