NT pro- B-type Natriuretic Peptide in the Small Ventricular Septal Defect in Children

Background: Brain natriuretic peptide is a cardiac hormone secreted from the left ventricular myocardium due to ventricular expansion and volume overload. A recent study shows that small VSD will have risk of ventricular dysfunction in adulthood. Another complications such as endocarditis, congestive heart failure, aortic regurgitation, arrhythmia also we should be aware. Evaluations of the plasma B-type natriuretic peptide level (NT pro BNP) are currently being considered as methods to identify the possible presence of ventricular dilation in small VSD. Objective: To evaluate the change in plasma B-type natriuretic peptide after transcatheter closure of VSD. Methods: A pretest-posttest design was conducted on VSD patients before and after transcatheter closure. Plasma B-type natriuretic peptide level were measured before and 30 days after the transcatheter closure of VSD. Result: A total of 32 peri membranous VSD patients were included in this study with 62.5 % female patients (n=20) and 37.5 % male patients (n=12). A significant decrease was observed in the median NT pro BNP level when the level before closure of 1.08 (0.74 – 3.47) ng/ml was compared to the level after closure of 0.91 (0.68 – 2.07) ng/ml (p<0.05). Conclusion: Significant decreases in NT pro BNP level are seen in small VSD patients 30 days after transcatheter closure. Patients with small peri membranous VSD are generally considered to need occlusion for their childhood defect.

Comparative efficacy of enalapril and valsartan in heart failure with mid-range ejection fraction

Aim. To compare the effectiveness of the angiotensin-converting enzyme inhibitor enalapril and the angiotensin II receptor antagonist valsartan in patients with heart failure with mid-range ejection fraction (HFmrEF) from the standpoint of the effect on the clinical picture, echocardiographic parameters and the level of the N-terminal fragment of the prohormone brain-type sodium (NT-proBNP). Methods. 110 patients with heart failure with mid-range ejection fraction were included in the study based on the City Clinical Hospital named after N.I. Pirogov of Orenburg between 2018 and 2020. All patients were divided into two randomized groups. Patients of the first group (n=55) were prescribed enalapril, the second group (n=55) valsartan. Each patient was followed up for 1 year. The six-minute walk test, NT-pro-brain natriuretic peptide level, echocardiography parameters were assessed in dynamics. Statistical analysis was performed by using Statistica 10.0 software, ShapiroWilk, MannWhitney, Wilcoxon tests. Results. During the year of observation in both groups, there was a significant decrease in the functional class of chronic heart failure (p 0.005) without a statistical difference between the groups (p=0.251). The distance during the six-minute walk test increased from 350 (310400) m to 490 (420530) m (p 0.001) in the first group, from 360 (330400) m to 510 (450520) m (p 0.001) in the second group, also without significant differences (p=0.361). The NT-pro-brain natriuretic peptide level decreased from 491 (410610) pg/ml to 286 (187350) pg/ml (p 0.001) in the first group, and from 446 (376534) pg/ml to 210 (143343) pg/ml (p 0.001) in the second, with a more significant change in the second group (p=0.020). The dynamics of echocardiography parameters were comparable in the groups (p 0.05), while ejection fraction normalized in 89.1% of patients received enalapril and 92.7% of patients received valsartan. Conclusion. The efficacy of enalapril and valsartan in heart failure with mid-range ejection fraction is comparable in its effect on the clinical picture and echocardiography parameters with a more pronounced decrease in NT-pro-brain natriuretic peptide when taking valsartan during a year of follow up.

Predictors of Post-Operative Acute Kidney Injury in relation with N-Terminal Pro-B-Type Natriuretic Peptide Level among Patients Undergoing Mitral Valve Replacement

Background: The N-terminal Pro-B-type natriuretic peptide (NT-proBNP) level can be utilized as post-operative prediction models suring cardiac surgery. Objective: The objective was to find out the predictors of post-operative acute kidney injury in relation with N-Terminal Pro-B-Type natriuretic peptide level among mitral valve replacement patients. Methodology: This cross-sectional study was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from January 2018 to December 2019. Patients with the age of more than or equal to 18 years with both sexes who were underwent mitral valve replacement were selected as study population. Patients were divided into two groups based on pre-operative NT-proBNP level. Post-operatively patients were observed on the basis of post-operative serum creatinine. Results: A total number of 100 patients were recruited for this study of which 50 cases were in group A and the rest of 50 cases were in the group B. Elevated NT-proBNP was the most powerful and independent pre-operative variable in predicting post-operative AKI development (OR 0.999, 95% CI 0.998-1.00) Conclusion: In conclusion elevated NT-proBNP is the most powerful and independent pre-operative variable in predicting post-operative acute kidney injury. Journal of Current and Advance Medical Research, July 2021;8(2):85-89

EXPRESS: Pulmonary Arterial Hypertension Associated with Congenital Heart Disease: Lessons Learnt from the Large Turkish Nationwide Registry (THALES)

Pulmonary hypertension is a group of diseases, including pulmonary arterial hypertension associated with congenital heart disease (APAH-CHD), characterized by progressive deterioration in pulmonary hemodynamics associated with substantial morbidity and mortality risk. THALES is a national multicenter, prospective observational registry, providing data on patients with APAH-CHD. The study comprised APAH-CHD patients (>3 months of age) with confirmed diagnosis of right heart catheterization or echocardiographic findings. Initial and follow-up data were collected via regular hospital visits. Descriptive statistics are used for definitive purposes. Overall, 1,034 patients aged 3 months–79 years (median 11.2 [Q1–Q3: 2.2–24.3] years) with APAH-CHD were enrolled at 61 centers, 50.3% being retrospectively enrolled. Most had either Eisenmenger's syndrome (49.2%) or systemic-to-pulmonary shunts (42.7%). Patients were mostly in functional class I–II at the time of diagnosis (46.6%). Mean 6-minute walk distance (6MWD) was 369±120 m. Mean pulmonary arterial pressure was 54.7±22.2 mmHg for the whole group, and was highest in patients with Eisenmenger's syndrome. Targeted therapies were noted in 398 (38.5%) patients (monotherapy in 80.4%). Follow-up data was available in 506 patients. Survival at 140 months was 79% and was associated with baseline 6MWD >440 m (p=0.009), brain natriuretic peptide level <300 ng/L (p <0.001). Follow-up 6MWD >165 m (p <0.0001), brain natriuretic peptide level <300 ng/L (p=0.031), and targeted therapies (p=0.004) were also predictive of survival. THALES is the largest registry dedicated to APAH-CHD to date and provides important contributions on demographics, clinical characteristics, and gaps in disease management.

A double-blinded, placebo-controlled randomized trial evaluating the efficacy and safety of Zhigancao Tang granules for treating HFpEF: study protocol for a randomized controlled trial

Background Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by diastolic dysfunction. Despite the increasing incidence of HFpEF, there is no available therapy that reduces the mortality rate of HFpEF. Zhigancao Tang has been used traditionally for the treatment of cardiovascular diseases in China. The use of traditional Chinese medicine (TCM) is associated with improvements in clinical syndromes and quality of life of patients. A randomized clinical trial should be conducted to provide clear evidence regarding the efficacy and safety of Zhigancao Tang granules for the treatment of HFpEF. Methods A randomized, double-blinded, placebo-controlled clinical trial was proposed. A total of 122 patients with HFpEF will be randomly assigned to receive Zhigancao Tang granules or placebo for 12 weeks. The primary outcome measure is cardiac function. The secondary outcomes include measurement of the integral TCM syndrome score, echocardiography, 6-min walk test, N-terminal-pro hormone B-type natriuretic peptide level, atrial natriuretic peptide level, Minnesota Living with Heart Failure scale, and Lee’s scale. The outcome measures will be evaluated at baseline, 4 weeks, and 12 weeks. Adverse events will be evaluated from baseline till the 12-week follow-up period. Discussion The results of this trial will demonstrate whether Zhigancao Tang granules are effective and safe for treating HFpEF. Trial registration ClinicalTrials.gov NCT04317339. Registered on 23 March 2020.

Liver Stiffness for Predicting Adverse Cardiac Events in Chinese Patients With Heart Failure: A Two-year Prospective Study

Background. To investigate whether liver stiffness (LS) can predict adverse cardiac events in Chinese patients with heart failure (HF). Methods. Total of 53 hospitalized patients with HF were enrolled and LS and tricuspid annual plane systolic excursion (TAPSE)were determined before discharge with Fibroscan® and Echocardiography. The patients were divided into two groups: High LS group(LS >6.9Kpa, n=23) and Low LS group(LS ≤6.9Kp, n=30) . Patients were followed up for 24 months at interval of 3 months. The endpoint of follow-up is death or rehospitalization for HF. Results. All patients were followed up for 24 months or until the endpoint. Patients in High LS group had lower platelet count(P=0.014), lower creatine clear rate (P=0.014), higher level of B-type natriuretic peptide at discharge(P=0.012), and lower tricuspid annual plane systolic excursion (P<0.001). During 24 months follow-up, 3(5.7%) deaths and 21(39.6%) hospitalization were observed. Patients in high LS group had a higher rate of death/rehospitalization when compared with patient in low LS group (Hazard ratio: 4.81; 95% confidence interval:1.69-13.7, P=0.003) after adjustment for age, sex, platelet count, creatine clear rate, and B-type natriuretic peptide level. Also, TAPSE≤16 can predict adverse cardiac events with HR of 6.63 (95% confidence interval:1.69-13.7, P=0.004) for age, sex, platelet count, creatine clear rate, and B-type natriuretic peptide level.Conclusion. LS and TAPSE may be considered for predicting worse outcomes for patients with heart failure.