Cutoff values of NT-proBNP for the prediction of low functional capacity, decreased ejection fraction and cardiovascular events in patients with heart failure

Background: It has been demonstrated in numerous studies that N-terminal pro-B-type natriuretic peptide (NT-proBNP) is strongly associated with left ventricular ejection fraction (LVEF), functional capacity (FC), and cardiovascular (CV) mortality in heart failure (HF) patients. The aim of the present study was to determine the predictive cutoff values of NT-proBNP for predicting these parameters. Methods: One hundred HF patients (88 male, 12 female, mean age 53.6 &#177; 8.9 years) with left ventricular (LV) systolic dysfunction and impaired exercise capacity were enrolled into the study. Echocardiographic examination was performed. The NT-proBNP concentration was measured after resting for 20 min in the supine position. The modified Bruce protocol was utilized for exercise testing. The patients were followed for between 690 and 840 days (mean 750 &#177; 30 days) for the occurrence of CV events. Results: There was a strong negative correlation between NT-proBNP concentration and LVEF (p < 0.004). It was found that NT-proBNP is a strong predictor of LVEF < 30% (p < 0.001). When 940 pg/mL was accepted as a cutoff value for NT-proBNP for the prediction of an LVEF < 30%, the sensitivity and the specificity were 89.8% and 71.4%, respectively. NT-proBNP and left atrial diastolic dimension were the most significant parameters for predicting FC (p < 0.001, each one). An NT-proBNP cutoff value of 940 pg/mL responded to 78.8% sensitivity and 81% specificity for the prediction of FC < 5 METs. The observed independent predictors for the CV events were NT-proBNP, LV mass index, and resting heart rate (p < 0.001, p = 0.02 and p = 0.006, respectively). Every 1000 pg/mL elevation in NT-proBNP level resulted in a 27% increase in the occurrence of CV events (p < 0.006). Moreover, 940 pg/mL NT-proBNP cutoff value revealed a sensitivity and specificity of 86.7% and 64.7% respectively for the prediction of incident CV events. Conclusions: Use of NT-proBNP cutoff values is easy and reliable method for the prediction of low FC and decreased LVEF, and may aid identification of patients at the highest risk for future CV events. We suggest to use NT-proBNP cutoff value of 940 pg/mL for predicting these parameters

A rare congenital anomaly: Pulmonary atresia and abnormal origin of right pulmonary artery

2MAR2041

Wartość prognostyczna nowo zdefiniowanej skali CHA2DS2-VASc-HSF w ocenie stopnia ciężkości choroby wieńcowej u chorych z zawałem serca z uniesieniem odcinka ST

Background: CHADS2 and CHA2DS2-VASc scores are widely used in clinical practice and include similar risk factors for the development of coronary artery disease (CAD). It is known that the factors comprising the newly defined CHA2DS2-VASc-HSF score promote atherosclerosis and are associated with severity of CAD. Aim: To investigate the association of the CHA2DS2-VASc-HSF score with the severity of CAD as assessed by SYNTAX score (SxS) in patients with ST segment elevation myocardial infarction (STEMI). Methods: A total of 454 consecutive patients with STEMI (males 79%, mean age 57.3 ± 12.9 years), who underwent primary percutaneous coronary intervention were included in our study. The patients were divided into three groups according to the SxS tertiles: low SxS group (SxS &lt; 14; 151 patients), intermediate SxS group (SxS 14–20; 152 patients), and high SxS group (SxS ≥ 21; 151 patients). Results: The CHADS2, CHA2DS2-VASc, and CHA2DS2VASc-HSF scores were found to be significantly different among the SxS groups (p &lt; 0.001, p &lt; 0.001, and p &lt; 0.001). After multivariate analysis, the CHA2DS2-VASc-HSF score was associated with high SxS (odds ratio [OR] 1.258, 95% confidence interval [CI] 1.026–1.544; p = 0.028) together with age (OR 1.032, 95% CI 1.013–1.050; p = 0.001) and ejection fraction (OR 0.927, 95% CI 0.901–0.955; p &lt; 0.001). Conclusions: A newly diagnosed CHA2DS2-VASc-HSF score predicts the severity of atherosclerosis in patients with STEMI.Wstęp: Skale CHADS2 i CHA2DS2-VASc są powszechnie stosowane w praktyce klinicznej. Uwzględniają one podobne czynniki ryzyka rozwoju choroby wieńcowej (CAD). Wiadomo, że czynniki zawarte w nowo zdefiniowanej skali CHA2DS2-VASc-HSF sprzyjają rozwojowi miażdżycy i wiążą się ze stopniem ciężkości CAD. Cel: Celem pracy było zbadanie związków między oceną w skali CHA2DS2-VASc-HSF a stopniem ciężkości CAD określonym za pomocą skali SYNTAX (SxS) u chorych z zawałem serca z uniesieniem odcinka ST (STEMI). Metody: Do badania włączono 454 kolejnych chorych z STEMI (mężczyźni 79%, średnia wieku 57,3 ± 12,9 roku) poddanych pierwotnej przezskórnej interwencji wieńcowej. Pacjentów podzielono na trzy grupy w zależności od tercyla punktacji w skali SxS: grupa z niską punktacją w skali SxS (SxS &lt; 14; 151 chorych), grupa z pośrednią punktacją w skali SxS (SxS 14–20; 152 chorych) i grupa z wysoką punktacją w skali SxS (SxS ≥ 21; 151 chorych). Wyniki: Stwierdzono, że między grupami SxS występowały istotne różnice w punktacji w skalach CHADS2, CHA2DS2-VASc i CHA2DS2VASc-HSF (p &lt; 0,001; p &lt; 0,001 i p &lt; 0,001). Po przeprowadzeniu analizy wieloczynnikowej punktacja w skali CHA2DS2-VASc-HSF wiązała się z wysokim wskaźnikiem SxS (iloraz szans [OR] 1,258; 95% przedział ufności [CI] 1,026–1,544; p = 0,028) oraz z wiekiem (OR 1,032, 95% CI 1,013–1,050; p = 0,001) i frakcją wyrzutową (OR 0,927; 95% CI 0,901–0,955; p &lt; 0,001). Wnioski: Nowo zdefiniowana skala CHA2DS2-VASc-HSF umożliwia ocenę stopnia ciężkości zmian miażdżycowych u chorych z STEMI.

Effect of Modified Global Risk Classification on Prognosis at Patients Undergoing Bypass Surgery and Percutaneous Coronary Intervention with Multi-vessel Disease

WOS: 000436145200010Objective: The aim of this study was to compare mortality and myocardial infarction in patients with multi-vessel disease using "Modified Global Risk Classification" (mGRC). Methods: We divided 579 patients into low, intermediate risk with a high EuroSCORE (IE), intermediate risk with a high SYNTAX score (IS), and high Modified Global Risk groups. Patients were evaluated for death, myocardial infarction, cerebrovascular events, need for re intervention, and a primary endpoint, which denotes the occurrence of any one of the four events. Results: Comparing the bypass surgery and percutaneous coronary intervention groups using mGRC showed significantly better prognostic results in the bypass surgery patients for the rate of the occurrence of the myocardial infarction for the IS group (p=0.047). In terms of the primary endpoint, the EuroSCORE, SYNTAX score, and Global Risk Classification (GRC) were found to be independent risk factors in logistic regression analysis. The ability of GRC to discriminate for the 1-year mortality was found to be better than that of the EuroSCORE and SYNTAX score. Conclusion: With the evaluation of the EuroSCORE and SYNTAX score together, the modified GRC, which includes both anatomical and clinical risk factors, provides an additional benefit for predicting the prognosis and decision of treatment in patients with multi-vessel disease