Biomedical subjects

John Lainchbury

Publications and source records attributed to John Lainchbury.

5 recordsLinked to original sources

PubMed2005

NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study.

AIMS: Experience with amino-terminal pro-brain natriuretic peptide (NT-proBNP) testing for evaluation of dyspnoeic patients with suspected acute heart failure (HF) is limited to single-centre studies. We wished to establish broader standards for NT-proBNP testing in a study involving four sites in three continents. METHODS AND RESULTS: Differences in NT-proBNP levels among 1256 patients with and without acute HF and the relationship between NT-proBNP levels and HF symptoms were examined. Optimal cut-points for diagnosis and prognosis were identified and verified using bootstrapping and multi-variable logistic regression techniques. Seven hundred and twenty subjects (57.3%) had acute HF, whose median NT-proBNP was considerably higher than those without (4639 vs. 108 pg/mL, P<0.001), and levels of NT-proBNP correlated with HF symptom severity (P=0.008). An optimal strategy to identify acute HF was to use age-related cut-points of 450, 900, and 1800 pg/mL for ages <50, 50-75, and >75, which yielded 90% sensitivity and 84% specificity for acute HF. An age-independent cut-point of 300 pg/mL had 98% negative predictive value to exclude acute HF. Among those with acute HF, a presenting NT-proBNP concentration >5180 pg/mL was strongly predictive of death by 76 days [odds ratio=5.2, 95% confidence interval (CI)=2.2-8.1, P<0.001]. CONCLUSION: In this multi-centre, international study, NT-proBNP testing was valuable for diagnostic evaluation and short-term prognosis estimation in dyspnoeic subjects with suspected or confirmed acute HF and should establish broader standards for use of the NT-proBNP in dyspnoeic patients.

Acute Disease↗

PubMed2005

Guiding and monitoring of heart failure therapy with NT-ProBNP: concepts and clinical studies.

BACKGROUND: Since 1988 with the discovery of B-type natriuretic peptide (BNP), many reports have confirmed the elevation of plasma BNP in symptomatic heart failure and confirmed that plasma levels are an independent predictor of death and cardiovascular events in both acute and chronic heart failure. METHODS AND RESULTS: A more slender evidence base attests that knowledge of plasma BNP levels can be used to produce clinical benefit. One randomized controlled trial demonstrated that measurements of N-terminal pro-brain natriuretic peptide (NT-proBNP) can be used to improve diagnostic accuracy in patients with heart failure in the community. A second study demonstrated that the provision of plasma BNP data improves the speed of diagnosis and reduces the rates of hospital admission and length of hospital stay (while reducing the costs of care) in patients with heart failure who are seen the emergency department with acute dyspnea. Finally, a randomized controlled pilot study demonstrated that serial measurements of NT-proBNP can be used to more effectively optimize heart failure pharmacotherapy with a concomitant improvement in outcome. CONCLUSION: The large body of observational data, coupled with this small but promising evidence base from controlled trials (which attests to beneficial effects on clinical outcomes) encourages an optimistic outlook for the further implementation of plasma BNP and/or NT-proBNP in the diagnosis and treatment of acute and chronic heart failure.

Cardiovascular Agents↗

PubMed2005

Health gains by using natriuretic peptides in diagnosis, prognosis and treatment.

The cardiac natriuretic peptides, and in particular plasma levels of the B-type natriuretic peptides, are acknowledged biomarkers of cardiac function and prognosis in cardiovascular disease. A growing body of evidence confirms plasma BNP and/or NT-proBNP are independent predictors of mortality and/or heart failure events in acute heart failure, established chronic heart failure, acute coronary syndromes and even in asymptomatic but at risk populations. Alongside this large body of associative observational data, there is a growing evidence base from controlled trials which indicates that knowledge of plasma B-type natriuretic peptide levels can be translated into improved clinical outcomes. Measurements of NT-proBNP improve diagnostic accuracy in patients presenting with heart failure in the community. Provision of plasma BNP data improves speed of diagnosis and reduces rates of hospital admission in patients with heart failure presenting with breathlessness (all whilst reducing overall costs). A randomised pilot study demonstrates serial measurements of NT-proBNP can assist in more effective optimisation of heart failure pharmacotherapy with a concomitant improvement in outcome. This finding has been corroborated by a recently reported multicentre study. Screening for left ventricular systolic dysfunction in the general population or in asymptomatic subjects at high risk of cardiovascular events appears to be cost-effective. This developing evidence base from controlled trials encourages further implementation of plasma BNP and/or NT-proBNP in diagnosis, risk stratification and management, not only of acute and chronic heart failure but also in those with coronary disease and asymptomatic subjects with cardiovascular risk factors.

Heart Failure↗

PubMed2004

Enteritis-associated myocarditis.

We describe two cases in which myocarditis was associated with a prodromal diarrhoeal illness as a result of bacterial enteritis. Both cases were associated with elevated troponin T and chest pain mimicking myocardial infarction.

Journal Article↗

PubMed2002

Plasma brain natriuretic peptide after long-term treatment for heart failure in general practice.

AIM: Plasma brain natriuretic peptide (BNP) concentrations are known to have high sensitivity and specificity in the diagnosis of heart failure in newly symptomatic patients. The relationship of plasma BNP to cardiac function in stable patients on long-term established treatment for heart failure is unknown. Plasma BNP was assessed for its ability to predict echocardiographic abnormality in 100 patients receiving long-term treatment in general practice for a provisional diagnosis of heart failure. METHODS AND RESULTS: BNP >35 pmol/l had a sensitivity and specificity of 69% and 67%, respectively, for a left ventricular ejection fraction of <45%. However, 19% of patients had an LVEF of below 45% whilst BNP was below 35 pmol/l. These patients, in whom a diagnosis of heart failure had been made years previously (mean 3.9 years), were all clinically stable on treatment. CONCLUSION: These findings support the view that BNP can be restored to normal levels in well-compensated patients despite persisting significant systolic dysfunction and suggest that BNP assays may be helpful for monitoring adequacy of therapy. BNP assays will have limited utility in the diagnosis of cardiac impairment once anti-failure therapy is well established and symptoms have been abolished.

Aged↗