The talk describes the utility and limitations of Brain Natriuretic peptide (BNP) and N-terminal proBNP (NT-pBNP) in the clinical management of heart failure
This document summarizes several studies related to sacubitril/valsartan (LCZ696):
- The TRANSITION trial found that initiating sacubitril/valsartan in hospital shortly after stabilization from acute heart failure had similar safety outcomes as initiating post-discharge. About 50% of patients achieved the top dose within 10 weeks.
- The PIONEER-HF trial showed that among patients hospitalized for acute heart failure, sacubitril/valsartan led to a greater reduction in NT-proBNP levels at 8 weeks compared to enalapril, with similar rates of adverse events.
- The landmark PARADIGM-HF trial demonstrated that sacubitril
The document discusses using BNP or NT-proBNP blood tests to screen for heart failure in primary care settings. It finds that NT-proBNP performed better than BNP in identifying patients with left ventricular systolic dysfunction. A cutoff of 150 pg/ml for NT-proBNP provided a high negative predictive value of 97.3%, avoiding unnecessary referrals while missing only one mild case of heart failure. The document proposes a study to evaluate implementing NT-proBNP screening in primary care practices to guide referrals for suspected heart failure.
Natriuretic peptides like BNP and NT-proBNP are important biomarkers for the diagnosis and management of congestive heart failure (CHF). BNP is released from cardiac ventricles in response to increased wall stress and levels correlate with left ventricular dysfunction. While both BNP and NT-proBNP can help diagnose CHF, NT-proBNP is more stable and its levels better predict mortality and rehospitalization risk in patients with CHF. The diagnostic accuracy of BNP and NT-proBNP can be affected by factors like renal function, obesity, and atrial fibrillation.
Biomarkers activity and the effect of nt pro bnp guided therapy in high risk ...drucsamal
This study evaluated 103 high-risk chronic heart failure patients after acute decompensation who were randomized to either NT-proBNP guided therapy or standard therapy. Biomarkers including NT-proBNP, sST2, copeptin, galectin-3, and troponin T were measured at baseline, 3 months, and 6 months. NT-proBNP guided therapy aimed to reduce NT-proBNP levels by at least 50% from baseline. NT-proBNP guided therapy resulted in greater reductions in biomarkers and lower rates of cardiovascular events compared to standard therapy over 10 months of follow-up. Biomarker changes correlated with improvements in left ventricular function and filling pressures, suggesting guided
This document summarizes the PARADIGM-HF clinical trial which compared the angiotensin receptor-neprilysin inhibitor LCZ696 to the ACE inhibitor enalapril in patients with heart failure and reduced ejection fraction. The trial found that LCZ696 was superior to enalapril in reducing cardiovascular death and hospitalization for heart failure. Specifically, LCZ696 reduced the risk of the primary composite outcome of death from cardiovascular causes or hospitalization for heart failure by 16% compared to enalapril. LCZ696 also reduced deaths from any cause by 16% compared to enalapril.
LCZ696 was more effective than enalapril in reducing the risks of CV death and HF hospitalization, CV death, HF hospitalization, and all-cause mortality in patients with heart failure with reduced ejection fraction. LCZ696 also provided incremental improvements in symptoms and physical limitations. LCZ696 was better tolerated than enalapril with lower rates of symptomatic hypotension, hyperkalemia, renal impairment, and cough.
This document summarizes several studies related to sacubitril/valsartan (LCZ696):
- The TRANSITION trial found that initiating sacubitril/valsartan in hospital shortly after stabilization from acute heart failure had similar safety outcomes as initiating post-discharge. About 50% of patients achieved the top dose within 10 weeks.
- The PIONEER-HF trial showed that among patients hospitalized for acute heart failure, sacubitril/valsartan led to a greater reduction in NT-proBNP levels at 8 weeks compared to enalapril, with similar rates of adverse events.
- The landmark PARADIGM-HF trial demonstrated that sacubitril
The document discusses using BNP or NT-proBNP blood tests to screen for heart failure in primary care settings. It finds that NT-proBNP performed better than BNP in identifying patients with left ventricular systolic dysfunction. A cutoff of 150 pg/ml for NT-proBNP provided a high negative predictive value of 97.3%, avoiding unnecessary referrals while missing only one mild case of heart failure. The document proposes a study to evaluate implementing NT-proBNP screening in primary care practices to guide referrals for suspected heart failure.
Natriuretic peptides like BNP and NT-proBNP are important biomarkers for the diagnosis and management of congestive heart failure (CHF). BNP is released from cardiac ventricles in response to increased wall stress and levels correlate with left ventricular dysfunction. While both BNP and NT-proBNP can help diagnose CHF, NT-proBNP is more stable and its levels better predict mortality and rehospitalization risk in patients with CHF. The diagnostic accuracy of BNP and NT-proBNP can be affected by factors like renal function, obesity, and atrial fibrillation.
Biomarkers activity and the effect of nt pro bnp guided therapy in high risk ...drucsamal
This study evaluated 103 high-risk chronic heart failure patients after acute decompensation who were randomized to either NT-proBNP guided therapy or standard therapy. Biomarkers including NT-proBNP, sST2, copeptin, galectin-3, and troponin T were measured at baseline, 3 months, and 6 months. NT-proBNP guided therapy aimed to reduce NT-proBNP levels by at least 50% from baseline. NT-proBNP guided therapy resulted in greater reductions in biomarkers and lower rates of cardiovascular events compared to standard therapy over 10 months of follow-up. Biomarker changes correlated with improvements in left ventricular function and filling pressures, suggesting guided
This document summarizes the PARADIGM-HF clinical trial which compared the angiotensin receptor-neprilysin inhibitor LCZ696 to the ACE inhibitor enalapril in patients with heart failure and reduced ejection fraction. The trial found that LCZ696 was superior to enalapril in reducing cardiovascular death and hospitalization for heart failure. Specifically, LCZ696 reduced the risk of the primary composite outcome of death from cardiovascular causes or hospitalization for heart failure by 16% compared to enalapril. LCZ696 also reduced deaths from any cause by 16% compared to enalapril.
LCZ696 was more effective than enalapril in reducing the risks of CV death and HF hospitalization, CV death, HF hospitalization, and all-cause mortality in patients with heart failure with reduced ejection fraction. LCZ696 also provided incremental improvements in symptoms and physical limitations. LCZ696 was better tolerated than enalapril with lower rates of symptomatic hypotension, hyperkalemia, renal impairment, and cough.
Assessing Congestion in HF : Natriuretic Peptidesdrucsamal
1) Natriuretic peptides (BNP, NT-proBNP) provide a quantitative measure of myocardial wall stress that correlates with heart failure symptoms and prognosis.
2) Elevated BNP/NT-proBNP levels strongly support the diagnosis of acute or chronic heart failure. Serial measurements can track changes in disease severity over time.
3) Patients with higher BNP/NT-proBNP levels or less reduction in levels following treatment have worse outcomes, including increased risk of death and heart failure hospitalization. Natriuretic peptide levels may help guide therapy adjustments.
Brain-type Natriuretic Peptide (BNP) - An Information Resource for Cardiac Ne...NHS Improvement
Brain-type Natriuretic Peptide (BNP) - An Information Resource for Cardiac Networks.
Produced by the NHS Heart Improvement Programme, this online document gives a brief overview of available information on Brain-type Natriuretic Peptide (BNP) testing as a ‘rule-out’ measure for echocardiogram when suspecting a diagnosis of heart failure.
(Updated July 2008).
CARDIOTalks: La IC vuelve a escena
22/05/2015 17:45h - 19:30h
Hotel Sevilla Center. Sala Giralda I, Sevilla (XII Reunión Anual de la Sección de Insuficiencia Cardiaca y Trasplante de la SEC)
http://cardiotalks.secardiologia.es
Top 3 Hits en Insuficiencia cardiaca en 2014
Dr. Nicolás Manito, Barcelona
Lo mejor del Congreso ESC 2014 de Barcelona
Jueves, 04 de Septiembre de 2014
De 19h a 20:30h
http://esc2014.secardiologia.es
Lo mejor sobre Insuficiencia Cardiaca
Dr. Esteban López de Sá
Hospital Universitario La Paz, Madrid
https://twitter.com/elopezdesa
The document discusses various biomarkers used in the diagnosis and management of heart failure. It states that natriuretic peptides like BNP and NT-proBNP are the most widely used biomarkers for heart failure as they are accurate for establishing diagnosis, determining severity, and predicting prognosis. It describes the release and function of these peptides. It also mentions other biomarkers like cardiac troponins, inflammatory markers, neurohormonal factors, and matrix proteins that provide additional information on myocardial injury, inflammation, neurohormonal activation, and remodeling in heart failure. A multimarker approach may help better classify and risk stratify heart failure.
The document summarizes a clinical trial that evaluated the angiotensin receptor-neprilysin inhibitor LCZ696 compared to the angiotensin converting enzyme inhibitor enalapril in patients with heart failure with reduced ejection fraction. The trial found that LCZ696 was superior to enalapril in reducing the composite outcome of cardiovascular death or heart failure hospitalization. LCZ696 also reduced rates of all-cause mortality and improved symptoms and physical limitations compared to enalapril. However, LCZ696 was associated with a higher risk of hypotension.
Angiotensin receptor-neprilysin inhibition(ARNI):The New Fronteir ?drucsamal
1) LCZ696, which inhibits neprilysin and blocks angiotensin receptors, reduced the risks of cardiovascular death and heart failure hospitalization compared to enalapril in patients with heart failure with reduced ejection fraction.
2) LCZ696 also reduced the risks of all-cause mortality and worsened heart failure compared to enalapril.
3) Patients receiving LCZ696 experienced greater improvements in quality of life and functional status measures compared to those receiving enalapril.
Estudio PARADIGM-HF: LCZ696 en Insuficiencia CardiacaCardioTeca
LCZ696, which inhibits both neprilysin and the angiotensin receptor, was compared to enalapril in the PARADIGM-HF trial involving over 8,000 patients with chronic heart failure and reduced ejection fraction. The trial found that LCZ696 reduced the primary composite endpoint of cardiovascular death or heart failure hospitalization by 20% compared to enalapril (HR 0.80, p=0.0000002). LCZ696 also reduced cardiovascular death alone by 20% compared to enalapril (HR 0.80, p=0.00004) and was generally well-tolerated with less cough and renal dysfunction, though there was more symptomatic hypotension with L
This randomized controlled trial compared the angiotensin receptor-neprilysin inhibitor LCZ696 to enalapril in over 8,400 patients with heart failure and reduced ejection fraction. It found that LCZ696 reduced the primary composite outcome of cardiovascular death or heart failure hospitalization by 20% compared to enalapril, as well as reducing overall mortality, cardiovascular mortality, heart failure hospitalizations, and improving symptoms. LCZ696 resulted in more hypotension and angioedema but less renal impairment, hyperkalemia, and coughing than enalapril.
This document discusses pharmacological management options for heart failure with reduced ejection fraction (HFrEF). The goals of treatment are to reduce symptoms, prolong survival, improve quality of life, and prevent disease progression. Key drug therapies recommended for prognosis include ACE inhibitors, ARBs, beta blockers, and mineralocorticoid receptor antagonists. Diuretics and digoxin are recommended to treat symptoms. Ivabradine may also be used for symptom control. Clinical trials have demonstrated the benefits of these drug classes in reducing mortality and hospitalizations.
The document provides information on the diagnosis and management of heart failure with preserved ejection fraction (HFpEF) according to ESC guidelines. It notes that HFpEF has a different epidemiological profile than heart failure with reduced ejection fraction (HFrEF), with older, female, obese, and hypertensive patients who are less likely to have coronary heart disease. The diagnosis of HFpEF is more difficult than HFrEF as other potential causes must be ruled out first. No treatments have convincingly reduced morbidity and mortality for HFpEF, though diuretics are used to control symptoms and treatment of comorbidities is important. The guidelines recommend controlling blood pressure and provide limited guidance for HFpEF management in
This document discusses several novel biomarkers for acute coronary syndrome (ACS). It describes C-reactive protein (CRP) as a marker of extensive vascular inflammation. High-sensitivity CRP levels above 10 mg/L are more predictive of outcomes in ACS patients. Soluble CD40 ligand and myoglobin are also discussed as inflammation markers. Microalbuminuria is related to endothelial dysfunction and an increased risk of cardiovascular disease. Cystatin C and metalloproteinases are associated with arterial stiffness and plaque degradation. Several microRNAs such as miR-1, miR-133 and miR-208 are described as potential biomarkers for myocardial infarction, cardiac hypertrophy, and arrhythmias.
Management strategy in HF with ARNI - Recent updates Praveen Nagula
- The document discusses management strategies for heart failure with reduced ejection fraction (HFrEF), including recent updates.
- It summarizes key differences between Indian and Western HF patients, noting that Indians develop HF at a younger age and with lower ejection fractions. Prognosis is also worse for Indian patients compared to those in the West.
- Core therapies for HFrEF are discussed, including a paradigm shift with the approval of sacubitril-valsartan which has been shown to reduce cardiovascular death compared to ACE inhibitors or ARBs alone in clinical trials.
This document discusses several cardiac channelopathies including Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia, idiopathic ventricular fibrillation, and early repolarization syndromes. It provides details on the electrocardiographic patterns, genetic causes, clinical manifestations, diagnosis and management of these conditions. Specifically, it focuses on the electrocardiographic patterns that define Brugada syndrome, the genetic and ion channel basis for the condition, and its association with sudden cardiac death.
Hurdles and new players in the management of chronic heart failure with reduc...Dhritisdiary
Watch the slideshow for a better understanding: https://youtu.be/CsXvS1hA330
1. Learn the standard therapy in HFrEF
2. Learn its challenges
3. Learn the new drugs for HFrEF.
This document summarizes information about LCZ696, an angiotensin receptor neprilysin inhibitor (ARNI). It provides mechanisms of action, summarizes clinical trial results, and discusses the potential of LCZ696 as a new treatment for heart failure. Key points include:
1) LCZ696 provides both neprilysin inhibition to increase natriuretic peptides and blockade of the renin-angiotensin-aldosterone system through AT1 receptor blockade.
2) In clinical trials, LCZ696 reduced blood pressure more than valsartan alone and reduced cardiovascular death and heart failure hospitalization more than enalapril in heart failure patients.
3) LCZ696 may offer
A review of the existing evidence that supports the current practice in perioperative medicine regarding Renin-angiotensin-aldosterone system antagonists, mainly ACE inhibitors and Angiotensin type 1 receptor blockers (ARB's).
Presented as the Cleveland Clinic Hospital Medicine Grand Rounds on April 1, 2009. CME AMA Category 1 - 1 hour.
Cardiac biomarkers such as BNP and NT-proBNP are useful for diagnosing and monitoring heart failure. The document discusses several studies that found BNP-guided treatment of heart failure reduced mortality rates compared to symptom-guided treatment. Measurement of BNP levels can aid clinical decision making in both acute and ambulatory heart failure patients. While useful, biomarkers have limitations and should be interpreted in the clinical context of each patient.
Summary of PROVE-HF and GUIDE-IT studies by Dr. Vaibhav Yawalkar MD, DM Cardi...vaibhavyawalkar
This document summarizes the PROVE-HF study which evaluated the effects of sacubitril/valsartan (ARNI) therapy on cardiac remodeling and biomarkers in patients with heart failure with reduced ejection fraction (HFrEF). The main findings were:
1) Significant reductions in NT-proBNP levels occurred within 2 weeks of starting ARNI and correlated with improvements in cardiac structure and function at 12 months including increased LVEF and reduced LV volumes.
2) Reverse cardiac remodeling occurred in all patient subgroups including those with new-onset HF, those who were ACEI/ARB naïve, and those who did not reach target ARNI doses.
3) Patients with the
Assessing Congestion in HF : Natriuretic Peptidesdrucsamal
1) Natriuretic peptides (BNP, NT-proBNP) provide a quantitative measure of myocardial wall stress that correlates with heart failure symptoms and prognosis.
2) Elevated BNP/NT-proBNP levels strongly support the diagnosis of acute or chronic heart failure. Serial measurements can track changes in disease severity over time.
3) Patients with higher BNP/NT-proBNP levels or less reduction in levels following treatment have worse outcomes, including increased risk of death and heart failure hospitalization. Natriuretic peptide levels may help guide therapy adjustments.
Brain-type Natriuretic Peptide (BNP) - An Information Resource for Cardiac Ne...NHS Improvement
Brain-type Natriuretic Peptide (BNP) - An Information Resource for Cardiac Networks.
Produced by the NHS Heart Improvement Programme, this online document gives a brief overview of available information on Brain-type Natriuretic Peptide (BNP) testing as a ‘rule-out’ measure for echocardiogram when suspecting a diagnosis of heart failure.
(Updated July 2008).
CARDIOTalks: La IC vuelve a escena
22/05/2015 17:45h - 19:30h
Hotel Sevilla Center. Sala Giralda I, Sevilla (XII Reunión Anual de la Sección de Insuficiencia Cardiaca y Trasplante de la SEC)
http://cardiotalks.secardiologia.es
Top 3 Hits en Insuficiencia cardiaca en 2014
Dr. Nicolás Manito, Barcelona
Lo mejor del Congreso ESC 2014 de Barcelona
Jueves, 04 de Septiembre de 2014
De 19h a 20:30h
http://esc2014.secardiologia.es
Lo mejor sobre Insuficiencia Cardiaca
Dr. Esteban López de Sá
Hospital Universitario La Paz, Madrid
https://twitter.com/elopezdesa
The document discusses various biomarkers used in the diagnosis and management of heart failure. It states that natriuretic peptides like BNP and NT-proBNP are the most widely used biomarkers for heart failure as they are accurate for establishing diagnosis, determining severity, and predicting prognosis. It describes the release and function of these peptides. It also mentions other biomarkers like cardiac troponins, inflammatory markers, neurohormonal factors, and matrix proteins that provide additional information on myocardial injury, inflammation, neurohormonal activation, and remodeling in heart failure. A multimarker approach may help better classify and risk stratify heart failure.
The document summarizes a clinical trial that evaluated the angiotensin receptor-neprilysin inhibitor LCZ696 compared to the angiotensin converting enzyme inhibitor enalapril in patients with heart failure with reduced ejection fraction. The trial found that LCZ696 was superior to enalapril in reducing the composite outcome of cardiovascular death or heart failure hospitalization. LCZ696 also reduced rates of all-cause mortality and improved symptoms and physical limitations compared to enalapril. However, LCZ696 was associated with a higher risk of hypotension.
Angiotensin receptor-neprilysin inhibition(ARNI):The New Fronteir ?drucsamal
1) LCZ696, which inhibits neprilysin and blocks angiotensin receptors, reduced the risks of cardiovascular death and heart failure hospitalization compared to enalapril in patients with heart failure with reduced ejection fraction.
2) LCZ696 also reduced the risks of all-cause mortality and worsened heart failure compared to enalapril.
3) Patients receiving LCZ696 experienced greater improvements in quality of life and functional status measures compared to those receiving enalapril.
Estudio PARADIGM-HF: LCZ696 en Insuficiencia CardiacaCardioTeca
LCZ696, which inhibits both neprilysin and the angiotensin receptor, was compared to enalapril in the PARADIGM-HF trial involving over 8,000 patients with chronic heart failure and reduced ejection fraction. The trial found that LCZ696 reduced the primary composite endpoint of cardiovascular death or heart failure hospitalization by 20% compared to enalapril (HR 0.80, p=0.0000002). LCZ696 also reduced cardiovascular death alone by 20% compared to enalapril (HR 0.80, p=0.00004) and was generally well-tolerated with less cough and renal dysfunction, though there was more symptomatic hypotension with L
This randomized controlled trial compared the angiotensin receptor-neprilysin inhibitor LCZ696 to enalapril in over 8,400 patients with heart failure and reduced ejection fraction. It found that LCZ696 reduced the primary composite outcome of cardiovascular death or heart failure hospitalization by 20% compared to enalapril, as well as reducing overall mortality, cardiovascular mortality, heart failure hospitalizations, and improving symptoms. LCZ696 resulted in more hypotension and angioedema but less renal impairment, hyperkalemia, and coughing than enalapril.
This document discusses pharmacological management options for heart failure with reduced ejection fraction (HFrEF). The goals of treatment are to reduce symptoms, prolong survival, improve quality of life, and prevent disease progression. Key drug therapies recommended for prognosis include ACE inhibitors, ARBs, beta blockers, and mineralocorticoid receptor antagonists. Diuretics and digoxin are recommended to treat symptoms. Ivabradine may also be used for symptom control. Clinical trials have demonstrated the benefits of these drug classes in reducing mortality and hospitalizations.
The document provides information on the diagnosis and management of heart failure with preserved ejection fraction (HFpEF) according to ESC guidelines. It notes that HFpEF has a different epidemiological profile than heart failure with reduced ejection fraction (HFrEF), with older, female, obese, and hypertensive patients who are less likely to have coronary heart disease. The diagnosis of HFpEF is more difficult than HFrEF as other potential causes must be ruled out first. No treatments have convincingly reduced morbidity and mortality for HFpEF, though diuretics are used to control symptoms and treatment of comorbidities is important. The guidelines recommend controlling blood pressure and provide limited guidance for HFpEF management in
This document discusses several novel biomarkers for acute coronary syndrome (ACS). It describes C-reactive protein (CRP) as a marker of extensive vascular inflammation. High-sensitivity CRP levels above 10 mg/L are more predictive of outcomes in ACS patients. Soluble CD40 ligand and myoglobin are also discussed as inflammation markers. Microalbuminuria is related to endothelial dysfunction and an increased risk of cardiovascular disease. Cystatin C and metalloproteinases are associated with arterial stiffness and plaque degradation. Several microRNAs such as miR-1, miR-133 and miR-208 are described as potential biomarkers for myocardial infarction, cardiac hypertrophy, and arrhythmias.
Management strategy in HF with ARNI - Recent updates Praveen Nagula
- The document discusses management strategies for heart failure with reduced ejection fraction (HFrEF), including recent updates.
- It summarizes key differences between Indian and Western HF patients, noting that Indians develop HF at a younger age and with lower ejection fractions. Prognosis is also worse for Indian patients compared to those in the West.
- Core therapies for HFrEF are discussed, including a paradigm shift with the approval of sacubitril-valsartan which has been shown to reduce cardiovascular death compared to ACE inhibitors or ARBs alone in clinical trials.
This document discusses several cardiac channelopathies including Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia, idiopathic ventricular fibrillation, and early repolarization syndromes. It provides details on the electrocardiographic patterns, genetic causes, clinical manifestations, diagnosis and management of these conditions. Specifically, it focuses on the electrocardiographic patterns that define Brugada syndrome, the genetic and ion channel basis for the condition, and its association with sudden cardiac death.
Hurdles and new players in the management of chronic heart failure with reduc...Dhritisdiary
Watch the slideshow for a better understanding: https://youtu.be/CsXvS1hA330
1. Learn the standard therapy in HFrEF
2. Learn its challenges
3. Learn the new drugs for HFrEF.
This document summarizes information about LCZ696, an angiotensin receptor neprilysin inhibitor (ARNI). It provides mechanisms of action, summarizes clinical trial results, and discusses the potential of LCZ696 as a new treatment for heart failure. Key points include:
1) LCZ696 provides both neprilysin inhibition to increase natriuretic peptides and blockade of the renin-angiotensin-aldosterone system through AT1 receptor blockade.
2) In clinical trials, LCZ696 reduced blood pressure more than valsartan alone and reduced cardiovascular death and heart failure hospitalization more than enalapril in heart failure patients.
3) LCZ696 may offer
A review of the existing evidence that supports the current practice in perioperative medicine regarding Renin-angiotensin-aldosterone system antagonists, mainly ACE inhibitors and Angiotensin type 1 receptor blockers (ARB's).
Presented as the Cleveland Clinic Hospital Medicine Grand Rounds on April 1, 2009. CME AMA Category 1 - 1 hour.
Cardiac biomarkers such as BNP and NT-proBNP are useful for diagnosing and monitoring heart failure. The document discusses several studies that found BNP-guided treatment of heart failure reduced mortality rates compared to symptom-guided treatment. Measurement of BNP levels can aid clinical decision making in both acute and ambulatory heart failure patients. While useful, biomarkers have limitations and should be interpreted in the clinical context of each patient.
Summary of PROVE-HF and GUIDE-IT studies by Dr. Vaibhav Yawalkar MD, DM Cardi...vaibhavyawalkar
This document summarizes the PROVE-HF study which evaluated the effects of sacubitril/valsartan (ARNI) therapy on cardiac remodeling and biomarkers in patients with heart failure with reduced ejection fraction (HFrEF). The main findings were:
1) Significant reductions in NT-proBNP levels occurred within 2 weeks of starting ARNI and correlated with improvements in cardiac structure and function at 12 months including increased LVEF and reduced LV volumes.
2) Reverse cardiac remodeling occurred in all patient subgroups including those with new-onset HF, those who were ACEI/ARB naïve, and those who did not reach target ARNI doses.
3) Patients with the
1. Biomarkers are measurable indicators of biological processes that can help diagnose, monitor, and guide treatment of heart failure.
2. Natriuretic peptides like BNP and NT-proBNP are useful biomarkers for diagnosing and risk-stratifying acute heart failure. Their levels are also impacted by factors like age, kidney function, and medications.
3. Biomarker-guided heart failure management that incorporates serial biomarker testing may help identify vulnerability, assess risk, and guide therapy in both event-driven and goal-directed approaches.
Ambulatory blood pressure measurement and bioimpedance analysis in chronic k...mohammad saad forghani
This document discusses the use of ambulatory blood pressure monitoring (ABPM) and bioimpedance in monitoring and treating hypertension in patients with chronic kidney disease (CKD). It notes that hypertension becomes more prevalent at higher stages of CKD. ABPM is described as superior to office blood pressure measurements for diagnosing hypertension, assessing treatment response, and predicting outcomes. Non-dipping blood pressure patterns observed on ABPM are associated with worse renal function and cardiovascular damage in CKD patients. The document also discusses how bioimpedance analysis can provide accurate assessment of volume status, an important factor in hypertension, with advantages of being non-invasive, inexpensive, and predictive of outcomes. Bedtime dosing of antihy
This document discusses the use of B-type natriuretic peptide (BNP) testing in the evaluation of heart failure. It describes the physiology of BNP release and important caveats when interpreting BNP levels. Landmark trials are summarized that demonstrate the clinical utility of BNP for diagnosing heart failure, risk stratification of patients, and guiding heart failure management. The document recommends ordering BNP testing to help diagnose heart failure in patients with ambiguous signs and symptoms, as well as to track changes in patients' clinical status and risk over time.
This document discusses hypertension management for angina. Some key points:
- Calcium channel blockers like nifedipine can reverse endothelial dysfunction and slow coronary artery calcification. They reduce blood pressure and myocardial oxygen demand.
- Beta blockers are beneficial for angina by reducing heart rate, blood pressure, and myocardial oxygen consumption. Carvedilol and metoprolol have shown mortality benefits in heart failure trials.
- ACE inhibitors and ARBs improve outcomes in heart failure and post-MI patients. Studies like SAVE, AIRE and TRACE found significant reductions in mortality with ACE inhibitors.
An Updated presentation of the management of severe sepsis including best evidence for fluid resuscitation, vasopressors, blood pressure target, steroid replacement, blood transfusion and other moralities.
This document summarizes guidelines for cardiac investigation and management of heart failure. It addresses:
- When to assess for coronary artery disease in heart failure patients
- Indications for endomyocardial biopsy and BNP testing
- Use of echocardiography and stress testing to evaluate patients
- Screening for rare diseases and comorbidities
- Use of cardiac resynchronization therapy and implantable cardioverter-defibrillators in heart failure
The document provides guidance on the appropriate use of diagnostic tests and treatments based on a patient's symptoms, ejection fraction, QRS duration, and response to medical therapy.
Natriuretic Peptide in CHF &ACS
BNP and NT-pro BNP are useful biomarkers for diagnosing and managing heart failure (HF) and acute coronary syndrome (ACS). Elevated levels indicate increased ventricular wall stress and correlate with worse outcomes. However, factors like obesity, renal function, age and pulmonary disease can affect levels. A BNP <100pg/mL or >500pg/mL has high accuracy to rule-out or rule-in HF, while levels between 100-500pg/mL require considering these factors. Serial measurements also help in monitoring HF therapy responses and predicting mortality risks.
- A study evaluated the efficacy and safety of alirocumab in adults with homozygous familial hypercholesterolemia.
- 45 patients received alirocumab and 24 received placebo for 78 weeks.
- Alirocumab reduced LDL-C levels by 24.8% compared to placebo and was well tolerated, with adverse events similar between groups.
- Alirocumab provided clinically significant LDL-C lowering in patients with homozygous familial hypercholesterolemia.
1) Natriuretic peptides like BNP and NT-proBNP are the most extensively studied and used biomarkers in heart failure. They are useful for diagnosis, assessing prognosis, and monitoring response to treatment.
2) Other biomarkers like troponins, ST2, galectin-3, and inflammatory markers can provide additional prognostic information beyond natriuretic peptides.
3) Biomarkers reflect different pathophysiological processes in heart failure like myocyte injury, stress, remodeling, neurohormonal activation, and inflammation. Used together, they can improve risk stratification and guidance of therapy.
1) Acute decompensated heart failure (ADHF) is a major public health problem, leading to high rates of hospitalization and mortality in older patients.
2) Measurement of plasma B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) can help diagnose ADHF in patients presenting with dyspnea and compatible symptoms when the diagnosis is uncertain.
3) Elevated BNP/NT-proBNP levels also provide prognostic information, with higher levels predicting worse outcomes including rehospitalization and death.
HTN among ESRD patients Current ReviewJAFAR ALSAID
This document discusses hypertension among patients with end-stage renal disease (ESRD) who receive dialysis. It defines key terms like chronic kidney disease (CKD) and ESRD. It then examines the epidemiology of hypertension in dialysis patients, challenges in measuring their blood pressure, and strategies for management. Home blood pressure monitoring is recommended over measurements just before or after dialysis, as home readings better predict health outcomes. Ambulatory blood pressure monitoring for 44 hours between dialysis sessions is also discussed as the gold standard for evaluation.
Low dose dopamine increases GFR and RBF. The DAD-HF trial investigated 60 patients randomized to low dose furosemide (continuous infusion 0.5 mg/kg/day) with or without low dose dopamine (2 μg/kg/min). Dopamine preserved renal function compared to furosemide alone in patients with acute decompensated heart failure. There were no significant differences found in a trial comparing high vs low dose furosemide or bolus vs continuous infusion on renal function or symptoms. Novel agents targeting fluid overload, renal function, contractility, and vasomotion may provide new therapeutic options for acute heart failure.
Prof. U. C. SAMAL provides an overview of acute decompensated heart failure and what is new in the field. He discusses similarities and differences between acute myocardial infarction and acute heart failure syndromes. Mortality rates are high for both conditions, though clinical benefits of interventions are greater for acute MI based on published clinical trials. The document then discusses definitions and classifications of acute heart failure syndromes, as well as guidelines for diagnosis and treatment from ESC and ACC/AHA. Biomarkers that can help with diagnosis, prognosis, and guiding therapy are also summarized.
Management for hypertension with case based approachParikshitMishra15
1) Cilnidipine, a calcium channel blocker that blocks both L-type and N-type calcium channels, is effective at reducing morning blood pressure when taken at bedtime as an add-on therapy for patients with uncontrolled morning hypertension.
2) Studies show cilnidipine is more favorable than other blood pressure medications for managing blood pressure in post-stroke patients. It significantly reduces blood pressure in post-stroke hypertensive patients over 12 months without differences in effectiveness between types of stroke.
3) Cilnidipine promotes regression of carotid intima-media thickness, a measure of atherosclerosis, in post-stroke patients and also reduces the inter-adventitial diameter of
This document summarizes changes in the treatment of acute kidney injury (AKI) over the last 10 years. It discusses epidemiological data on AKI from a large trial showing high mortality. It covers prevention of contrast-induced nephropathy including hydration protocols and acetylcysteine. Dose and modality of renal replacement therapy are discussed, with studies showing benefits of continuous over intermittent dialysis. Management of fluid balance in sepsis and AKI is also summarized.
This document discusses initiating treatment with angiotensin receptor-neprilysin inhibitors (ARNi) in patients hospitalized for acute heart failure with reduced ejection fraction (HFrEF). It summarizes the PIONEER-HF trial which found that initiating sacubitril-valsartan at discharge led to greater reductions in NT-proBNP levels and fewer hospital readmissions for heart failure compared to enalapril. The document concludes that initiating ARNi de novo without prior ACEi/ARB exposure is a safe and effective strategy based on recent data, but close monitoring is needed due to risks of hypotension and angioedema.
REVIEW ARTICLE SEPTEMBER 2021 medical.pptxArunDeva8
This document summarizes the evolving use of biomarkers in the management of heart failure. It discusses how biomarkers such as BNP, NT-proBNP, cTn, ST2, and galectin-3 can be used to diagnose heart failure, establish disease prognosis and severity, and predict patient outcomes. Elevated levels of these biomarkers are associated with worse symptoms and higher mortality in heart failure patients. The document also presents a case study of an elderly male patient presenting with heart failure symptoms and discusses the clinical implications of his elevated BNP and cTnT biomarker levels.
Similar to Utility of Cardiac Biomarkers in Clinical Heart Failure Care (20)
A 94-year-old woman was admitted to the hospital twice within a month for dizziness and high blood pressure. During her second admission, a nurse noted foul-smelling urine but the patient had no urinary tract symptoms. A urine dipstick and culture found significant bacteriuria with E. coli growth over 100,000 colonies/ml. Though asymptomatic, the patient was diagnosed with a urinary tract infection and prescribed antibiotics. The document discusses that asymptomatic bacteriuria is common in elderly women and others, and treatment generally does not provide benefits and can increase risk of resistant infections, so screening and treatment is only recommended under certain conditions like pregnancy.
By learning what to say, and what not to say, you can avoid missunderstandings and conflicts. From personal life to top leadership, every one can benefit by learning some simple rules of effective feedback
Human beta cells express several TRP channel transcripts including TRPC1, TRPM2, TRPM3, TRPM4, TRPM7, TRPML1, TRPML3, and TRPP1. TRP channels may mediate the "background current" required for plasma membrane depolarization and insulin secretion. Further research is needed to understand the specific functions of TRP channels in human beta cells and their role in insulin secretion.
A 71 year old man with peripheral edema pleural effusion ascites and breathle...Md. Shahidul Islam
A 71 year old man with peripheral edema, pleural effusion, ascites and breathlessness. See how one thing led to another, and the final diagnosis and treatment
Many doctors in many hospitals in many countries do not use proper hospital attire, and do not follow basic hygiene routines. Doctors use their private clothes, or other inappropriate attire in the hospitas,l and carry home the dirty clothes contaminated with resistant bacteria and spores. By this way they spread infection from patient to patient, from clinics to clinics, and from hospitals to the homes and communities. This must stop.
Success rates in specialist training and certification programs should be nearly 100%. This can be achieved by a structured and supervised specialist training program. In such programs, the need for end-of-five year examination is questionable. These slides are basis of a lecture that illustrates the specialist training and certification program in internal medicine in Sweden
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
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15. Plasma BNP concentration predicts survival in
Heart failure patients. Anand IS et al 2003, Circulation,
107:1278
16. Hartmann F et al 2004 Circulation 110:1780
One year mortality 7%
One year mortality 21.6%
17. Hartmann F et al 2004 Circulation 110:1780
2.5 fold higher risk of
death or hospitalization
18. BNP or NT-pBNP?
No accepted conversion factor
BNP >100 ng/l is roughly equivalent to
NT-pBNP > 900 ng/l for HF diagnosis
NT-pBNP has greater prognostic value
NT-pBNP is more sensitive to renal function
NT-pBNP is useful during treatment with ARNI
or neseritide
NT-pBNP and BNP assays probably detect proBNP
19. Variability of BNP and NT-pBNP
Intraindividual biologic variatian and analytic assay variation
Significant difference in results over time depends on the total
variability (RCV percentage change, or Relative Change Value)
Significant change for NT-pBNP: 11% decrease in day do day
values, or 47% decrease in week to week values
Significant change for BNP: 25% decrease in day do day
values, or 72% decrease in week to week values
Wu AH et al, Am Heart J 2006; 152:828
19
20. Disadvantages of BNP / NT-pBNP
A high NP doesn not exclude other co-exixting diseases
NPs do not increase in some acute HF
Some patients with severe chronic HF have high NP
Right heart failure due to lung disease or left ventricular disease
have high NPs
NP measurement must be combined with clinical assessment
Special case for people treated with nesiritide or sacubritil
20
21. NT-pBNP in patients with renal failure
NT-pBNP is excreted by the kidney
Cut-off values in patients with GFR <60 ml/min:
>1200 ng/l
Cut-off values in patients with GFR >60 ml/min:
>450 ng/l for patients < 50 years
>900 ng/l for patients > 50 years
In patients with GFR > 60, sensitivity 85%, specificity 88%; In patients
with GFR <60 sensitivity 89%, specificity 72%
Anwaruddin, S et al, J Am Coll Cardiol 2006; 47:91
21
22. Value of serial NT-pBNP guided therapy
Not useful in acute HF
In chronic HF the results are mixed
NT-pBNP guided therapy reduces mortality in patients
< 75 years.
NT-pBNP guided therapy helps achieving target dose
of ACE-I and beta blockers in patients < 75 years
Porapakkham P et al Arch Intern Med 2010; 170:507
22
24. 0
,2
,4
,6
,8
1
Cum.Survival
0 25 50 75 100 125 150 175 200
Time (months)
High BNP and high E/e’
High BNP and Low E/e’
Low BNP and low E/e’
P < 0.0001
Low BNP and High E/e’
All-cause mortality in patients with chronic heart failure categorized according to B-
type natriuretic peptide (BNP) levels and the ratio of transmitral blood flow to
myocardial early diastolic velocities (E/e’). Simioniuc A et al, Int J Cardiol
2016;224:416-423
WHO Diabetes info
Islet function and physiology
Ca2+ signaling is also as a functionality analysis for islet transplantation as well.
Ca2+ signaling pattern indicator
Ca2+ is vital for the heterogenous insulin secretion pathways
Oscillation in ca2+ is considered to be ameasure of functionality of islets (PMID: 18818288)
Non oscillatory have diminished glucose sensitivity and this is earlier sign of islet dysfunction.
Kaplan-Meier analysis of cumulative rates of survival in CHF patients with left ventricular dysfunction stratified into two groups on the basis of median plasma concentration (73 pg/mL) of BNP.