BNP

Mitochondrial and Cardiolipin Adaptations to Ventricular Assist Device Support in Pediatric Versus Adult Failing Myocardium.

Caitlyn S Conard, Mariana Casa de Vito, Obed O Nyarko +11 more

Ventricular assist devices (VADs) are used as treatment for end-stage heart failure in children and adults. We previously demonstrated decreased mitochondrial function and changes in cardiolipin, a mitochondrial phospholipid, in explanted pediatric and adult failing hearts. In this study, we tested the hypothesis that VAD unloading of failing hearts leads to positive changes in myocardial cardiolipin in both pediatric and adult hearts.

Albumin-Bilirubin Score and Subclinical Right Ventricular Dysfunction After Repair of Tetralogy of Fallot.

Erhan Sönmez, Özge Pamukçu Akay, Yunus Emre Kum +3 more

Right ventricular (RV) dysfunction is a key determinant of long-term morbidity in patients following surgical repair of tetralogy of Fallot (TOF). Identifying practical biomarkers for early detection of right-sided heart failure remains clinically relevant, particularly in pediatric populations with subclinical disease. The albumin-bilirubin (ALBI) score, a simple and objective marker of hepatic function, has emerged as a potential surrogate of systemic congestion in heart failure. This study aimed to evaluate whether the ALBI score reflects right ventricular dysfunction in pediatric patients after TOF repair and to examine its relationship with N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiographic indices.

Analyzing Vital Sign Variability in Remote Monitoring as a Predictor of 31-Day Heart Failure Readmission: A Retrospective Cohort Study.

Adeel Arif, Anshul Kumar, Michelle Elsener +2 more

Heart failure (HF) is a major cause of morbidity and early hospital readmission in the United States. Remote patient monitoring (RPM) is increasingly used to support postdischarge care, but evidence remains mixed, and the prognostic value of day-to-day vital sign variability is unclear. This study evaluated whether physiologic variability and patient engagement during RPM were associated with 31-day HF readmission.

B-type natriuretic peptide attenuates TLR-induced cytokine and chemokine secretion in monocyte-derived Langerhans cells.

Dorottya Horváth, Zsófia Pénzes, Petra Molnár +6 more

B-type natriuretic peptide (BNP) is a well-known cardiac hormone and biomarker of heart failure, but emerging evidence suggests that it also possesses immunomodulatory properties, including a role in inflammatory skin conditions like atopic dermatitis (AD). Langerhans cells (LCs), specialized epidermal antigen-presenting cells, orchestrate cutaneous immunity and are targets of neuropeptides. In the present study, we investigated how BNP treatment during differentiation affects the activation, cytokine profile, and interaction of immune cells with moLCs subsequently activated via Toll-like receptors (TLRs).

Efficacy and safety of sacubitril/valsartan in patients on peritoneal dialysis: a systematic review and meta-analysis.

Caio Lima da Silva, Pandora Eloa Oliveira Fonseca, Viviane Calice-Silva +3 more

Sacubitril/valsartan is a recommended medication for managing heart failure (HF). However, its role in peritoneal dialysis (PD) patients remains uncertain. We conducted this systematic review and singlearm meta-analysis to assess the efficacy and safety of sacubitril/valsartan in this population.

Sensing performance of ScTiO3 film-based EIS arrays through co-sputtering for pH sensing and heart failure biomarker monitoring.

Tung-Ming Pan, Chia-Yu Kuo, Jim-Long Her +1 more

In this work, a ScTiO3 sensing film array was fabricated on a p-type Si substrate using a co-sputtering technique and subsequently integrated into electrolyte-insulator-semiconductor (EIS) platforms for both pH sensing and N-terminal pro-B-type natriuretic peptide (NT-proBNP) detection, a clinically important biomarker for heart failure (HF) diagnosis. To evaluate the structural, interfacial, and sensing characteristics, the films underwent RTA at temperatures between 600 and 800 °C. Extensive material characterization, including X-ray diffraction, X-ray photoelectron spectroscopy, Auger electron spectroscopy, transmission electron microscopy, and atomic force microscopy, revealed a strong correlation between the microstructural evolution of the ScTiO3 films and their sensing performance. Superior sensing characteristics were observed in the film annealed at 700 °C, which recorded the highest sensitivity (65.07 mV/pH) alongside impressive stability metrics, including a 0.26 mV/h drift rate and 1.2 mV hysteresis. Furthermore, to enable specific NT-proBNP detection, the ScTiO3 surface was first functionalized with APTES and then conjugated with EDC/NHS-activated antibodies, facilitating precise antigen-antibody interactions. The resulting ScTiO3-based array EIS biosensor demonstrated excellent analytical performance, delivering a high sensitivity of 10.84 mV/pCNT-proBNP over a wide dynamic detection range from 10-4 to 106 pg/mL. Collectively, these results highlight the strong potential of a ScTiO3 sensing film array as high-performance platforms for reliable pH monitoring and advanced biomedical diagnostics, particularly for sensitive and accurate NT-proBNP detection in HF applications.

Prospective cohort study of TIMP-1 and myocardial fibrosis in Chagas disease at a reference clinic in Pernambuco, Brazil: PTICH trial protocol.

Sílvia Marinho Martins, Carolina The Macedo, Cassio Santana Meira +7 more

Chagas disease affects millions of individuals across Latin America and imposes a substantial economic burden on healthcare systems, particularly in rural and underserved regions. Chronic Chagasic cardiomyopathy remains one of the leading causes of heart failure-related mortality in endemic countries. Tissue inhibitor of metalloproteinases-1 (TIMP-1) has emerged as a potential biomarker of myocardial fibrosis in cardiomyopathies. This study was designed to investigate the association between TIMP-1 and myocardial fibrosis in chronic Chagas disease and to assess its potential as an early biomarker of fibrotic remodelling.

Biomarker-Guided Versus Clinically Guided Management Strategies for Heart Failure: A Systematic Review and Meta-Analysis.

Hao Zhou, Ting Liu, Fuxia Lan +3 more

The clinical value of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided therapy for improving outcomes in patients with heart failure (HF) remains controversial. Thus, this meta-analysis synthesizes the available evidence from randomized controlled trials (RCTs) to determine whether a biomarker-guided strategy reduces all-cause mortality and HF-related hospitalizations compared with clinically guided management.

Prognostic value of cardiopulmonary exercise testing in connective tissue disease-associated pulmonary arterial hypertension at low and intermediate-low risk.

Yixin Zhang, Linwei Shan, Jiayi Dai +6 more

Pulmonary arterial hypertension (PAH) is a severe complication of connective tissue disease (CTD) and a leading cause of mortality in affected patients. Although the COMPERA 2.0 model is widely used for risk stratification in PAH, its ability to discriminate prognosis among low-risk patients remains limited. This study aimed to explore the prognostic predictive role of cardiopulmonary exercise testing (CPET) in CTD-PAH patients classified as low or intermediate-low risk by COMPERA 2.0.

Cardiac biomarkers response under angiotensin receptor-neprilysin inhibitor: a sub-analysis of the NATRIUM-HF study.

Jolie Bruno, Aziz Daghmouri, Malha Sadoune +13 more

Natriuretic peptides (NPs) are central to the diagnostic and therapeutic management of heart failure (HF), yet their short-term dynamics under sacubitril/valsartan (S/V) therapy and during acute volume changes remain incompletely characterized. We aimed to assess changes in circulating biomarkers and response to standardized acute intravascular volume expansion and diuretic treatment before and after S/V initiation.

Effects of intravenous furosemide plus small-volume hypertonic saline solutions on inflammatory, remodelling markers and epigenetics signatures of patients with congestive acute decompensated heart failure (ADHF).

Mario Daidone, Alessandra Casuccio, John Sebastian Soldano +14 more

In a randomised controlled trial (RCT), we compared the effects of treatment with furosemide + small volumes of hypertonic saline solution (HSS) with those of furosemide alone in patients with decompensated heart failure (HF), and their effects on inflammatory and remodelling markers and epigenetic signatures.

Insights into the renin-angiotensin-aldosterone system in transthyretin amyloid cardiomyopathy.

Christina Kronberger, Oliver Domenig, Noemi Pavo +14 more

This study aimed to characterize circulating renin-angiotensin-aldosterone system (RAAS) patterns in transthyretin amyloid cardiomyopathy (ATTR-CM), examine their relationship with clinical and echocardiographic parameters and determine their prognostic value.

Tanshinone-IIA Mediated Attenuation of Post-Infarction Myocardial Fibrosis via IL-33/ST-2 Signaling Changes in Rat Epicardial Adipose Tissue.

Kehan Gao, Xingming Xu, Minyan Sun +6 more

Myocardial infarction (MI), a severe form of coronary artery disease, often results in myocardial fibrosis, a key contributor to cardiac dysfunction and heart failure. Epicardial adipose tissue (EAT) is increasingly implicated in cardiovascular pathology through cytokine-mediated modulation of cardiac function. Tanshinone IIA (TanIIA), a lipophilic compound derived from Salvia miltiorrhiza, exhibits anti-inflammatory, antioxidant, and anti-fibrotic properties. This study aimed to evaluate the therapeutic potential of TanIIA in attenuating post-MI myocardial fibrosis and to explore its underlying mechanisms using an integrative approach combining in vivo experiments and in silico analyses. A murine MI model was established, and molecular docking was employed to assess TanIIA binding to key components of the interleukin-33/growth stimulation expressed gene 2 (IL-33/ST2) signaling pathway. Our results showed that TanIIA treatment significantly enhanced cardiac function, reduced histological injury, and mitigated myocardial fibrosis, alongside decreased serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI). TanIIA also attenuated inflammatory responses and oxidative stress in the serum, myocardium, and EAT. Mechanistically, TanIIA downregulated IL-33 and ST2 expression, suppressed the myeloid differentiation factor 88 (MyD88)/nuclear factor kappa-B (NF-κB) pathway, and reduced transforming growth factor-β1 (TGF-β1) levels. In silico analyses further revealed that TanIIA exhibited strong binding affinities for IL-33, ST2, MyD88, and NF-κB p65, with the most stable interaction predicted for ST2. Collectively, these findings indicate that TanIIA alleviates MI-induced myocardial fibrosis by modulating EAT-associated inflammation and oxidative stress, potentially via multi-target inhibition of the IL-33/ST2 axis. These results support TanIIA as a promising therapeutic candidate for the management of post-infarction myocardial fibrosis.

Heart Failure Therapy Improves Outcomes in Adults With Congenital Heart Disease and Left Ventricular Dysfunction.

Zeyad M Kholeif, Mohamed Ellabbad, William R Miranda +5 more

There are limited data about the role of guideline-directed medical therapy (GDMT) in adults with congenital heart disease presenting with heart failure with reduced ejection fraction.

Serum malondialdehyde predicts mortality in patients with acute heart failure.

Marija Pinterić, Iva Klobučar, Margarete Lechleitner +7 more

Acute heart failure (AHF) is associated with high short- and long-term mortality, and early identification of patients at highest risk remains challenging despite the use of established biomarkers and clinical risk scores. Oxidative stress plays a central role in the pathophysiology of AHF but has been insufficiently investigated as a prognostic target. This study aimed to evaluate the prognostic value of serum oxidative stress biomarkers for predicting short- and long-term mortality in AHF patients and to determine whether they improve risk stratification beyond established tools.

Prognostic Value of a Low-Cost LDH-Hemoglobin-Albumin Biomarker Panel in Acute Heart Failure: A Real-World Cohort from a Resource-Limited Setting.

Can Baba Arin

Background: In many low- and middle-income countries, access to advanced cardiac biomarkers such as B-type natriuretic peptide (BNP) and NT-pro BNP remains limited, posing challenges for early risk stratification in patients hospitalized with acute heart failure (AHF). Identifying simple, inexpensive, and universally available laboratory markers with prognostic value is of practical clinical importance. Methods: Consecutive patients (≥18 years) hospitalized with acute heart failure (AHF) between May 2022 and November 2024 were retrospectively analyzed. After exclusion of patients with incomplete outcome data, in-hospital mortality was assessed using logistic regression analysis. Hemoglobin, serum albumin, lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), and the C-reactive protein-albumin-lymphocyte (CALLY) index were evaluated as potential predictors of in-hospital mortality. Results: A total of 211 patients were included in the mortality analysis, with an in-hospital mortality rate of 10.0%. Patients were stratified by anemia and hypoalbuminemia status, revealing significant differences in unadjusted mortality rates across groups (p = 0.04). However, after adjustment for age, sex, and chronic kidney disease, the prognostic impact of anemia and hypoalbuminemia was attenuated. Elevated LDH levels remained independently associated with in-hospital mortality (adjusted odds ratio 2.84, 95% confidence interval 1.01-8.02). Higher NLR values and lower CALLY index levels showed nonsignificant trends toward adverse outcomes. Conclusions: In this real-world cohort from a resource-limited setting, LDH emerged as a practical and independent predictor of in-hospital mortality in patients with AHF. When access to natriuretic peptides is limited, LDH-supported by routinely available laboratory parameters-may assist early risk stratification and clinical decision-making.

Comparative Long-Term Outcomes of Anatomical and Physiological Repair for Corrected Transposition.

Yuji Tominaga, Masashi Takeshita, Takuji Watanabe +5 more

The optimal surgical strategy for congenitally corrected transposition of the great arteries (ccTGA) remains debated. This study aimed to compare the long-term outcomes of each surgical approach and to explore the optimal management strategy.

Efficacy comparison of dapagliflozin combined with liraglutide versus monotherapy in obese patients with heart failure.

Guangzhi Zhou, Aijun Liu, Xiabing Hu +2 more

This study aimed to evaluate the efficacy and safety of dapagliflozin combined with liraglutide versus monotherapy in obese patients with heart failure with preserved ejection fraction (HFpEF). This retrospective study enrolled 360 obese patients with HFpEF, who were divided into 3 groups according to different treatment methods: the combination group (dapagliflozin + liraglutide), the dapagliflozin group, and the liraglutide group, with 120 patients in each group. The intervention duration was 24 weeks. The primary endpoints included changes in N-terminal pro-B-type natriuretic peptide levels, 6-minute walk distance, and cardiac structural parameters. Secondary endpoints included metabolic indicators (weight, blood glucose, etc) and safety outcomes. After 24 weeks of intervention, the combination group showed a more significant decrease in B-type natriuretic peptide levels (P < .05) and a greater improvement in 6-minute walk distance (P < .05) compared with the 2 monotherapy groups. In terms of metabolic indicators, the combination group had greater weight loss (P < .05) and better blood glucose control (P < .05). The incidence of major cardiovascular composite endpoints in the combination group was lower than that in the monotherapy groups (P < .05). The overall incidence of adverse events was similar among the 3 groups (P > .05). Dapagliflozin combined with liraglutide has a synergistic effect in improving cardiac function and metabolic disorders in obese patients with HFpEF, with good safety, providing a more effective therapeutic strategy for clinical practice.

Mid-regional pro-atrial natriuretic peptide in managing cardiovascular and cerebrovascular diseases.

Xu-Lei Hao, Gjin Ndrepepa, Wen-Qi Zheng +1 more

Mid-regional pro-atrial natriuretic peptide (MR-proANP), along with B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), is a type of natriuretic peptide hormone that is released by atrial muscle cells upon stress. Previous studies have shown that MR-proANP has high diagnostic accuracy for heart failure (HF) in several clinical settings, and it also helps in the risk stratification of patients with HF. In the general population, elevated MR-proANP levels indicate a high risk of cerebrovascular and cardiovascular diseases, including stroke and atrial fibrillation. In patients with established cardiovascular and cerebrovascular diseases, elevated MR-proANP levels are associated with a poor prognosis. This review summarizes the value and the use of MR-proANP in assessing the risk, diagnosis, and prognosis of patients with cardiovascular and cerebrovascular disease(s).

Diagnostic Value of Serum sCD40L, CCL3, and NT-ProBNP Levels in Detection of Lower Limb Venous Thrombosis among Elderly Patients with Heart Failure.

Xuelian Liu, Lina Mu, Shasha Ma +1 more

The serum levels of soluble CD40 ligand (sCD40L), cytokine ligand 3 (CCL3), and N-terminal pro-brain natriuretic peptide (NT-proBNP) are closely associated with heart failure (HF).

Decoding the Heart Failure Peptidome.

Christian T Madsen, Jan C Refsgaard, Geert H D Voordes +8 more

Peptides such as angiotensin II and brain natriuretic peptide are pivotal in diagnosing and treating heart failure (HF). However, unbiased systematic studies of the peptidome in patients with HF are lacking. Deciphering the plasma peptidome might significantly improve the diagnosis, prognostication, and treatment of patients with HF.

Efficacy of rhBNP in heart failure with atrial fibrillation combined with poor conventional therapy response and recurrence risk factors.

Huijuan Shang, Xiaojun Wang, Xiaoyin Shi +1 more

To evaluate the efficacy of recombinant human brain natriuretic peptide (rhBNP) in patients with acute decompensated heart failure (ADHF) complicated with atrial fibrillation (AF) and poor response to conventional treatment.

Invasive Confirmation of Microvascular Recovery Parallel to Left Ventricular Functional Restoration.

Takumi Toya, Takumi Kondo, Otoya Sekine +7 more

Coronary microvascular dysfunction (CMD) is increasingly implicated in heart failure, but reversal with guideline-directed medical therapy (GDMT) is rarely documented using invasive physiology.

Effect of Fluid Restriction in Heart Failure: A Meta-Analysis of Randomized Controlled Trials.

Maryam Sajid, Shahzaib Ahmed, Taimor Mohammed Khan +6 more

Fluid restriction is frequently recommended for patients with heart failure (HF) to prevent volume overload, yet its clinical benefit remains uncertain. This meta-analysis compared the efficacy and safety of fluid restriction versus liberal fluid intake in HF by systematically searching PubMed, Scopus, and Cochrane CENTRAL through May 2025 for randomized controlled trials evaluating fluid restriction (≤1.5 L/d) compared with liberal intake in adults with HF. Outcomes included re-hospitalization, mortality, weight, thirst, quality of life (QoL), intravenous diuretic use, and serum biomarkers such as sodium, creatinine, and brain natriuretic peptide. Ten randomized controlled trials involving 1465 participants (731 fluid restriction; 734 liberal intake) were included. Fluid restriction was associated with a 29% relative reduction in re-hospitalization (relative risks [RR] 0.71; 95% confidence interval [CI], 0.50-1.02; P = 0.06; I2 = 52%) and mortality (RR 0.71; 95% CI, 0.43-1.18; P = 0.19; I2 = 0%), although neither reached statistical significance. Weight reduction favored fluid restriction (weighted mean difference [WMD] -1.58 kg; 95% CI, -3.92 to 0.76), but findings varied across studies. No significant differences were observed for thirst (WMD 4.96), QoL (standardized mean difference [SMD] 0.15), intravenous diuretic use, sodium levels (WMD 0.90 mmol/L), creatinine (WMD -0.10 mg/dL), or brain natriuretic peptide (WMD -51.41 pg/mL). Subgroup analysis showed that liberal fluid intake significantly reduced creatinine in chronic compensated HF, whereas no benefit was found in acute decompensated HF. Sensitivity analyses identified one outlier trial as the primary source of heterogeneity. Overall, fluid restriction does not significantly improve outcomes in HF, and liberal fluid intake appears safe, supporting more individualized fluid strategies.

Total body water to lean body mass ratio predicts mortality in patients with chronic heart failure: a prospective, observational study.

Linfeng Xie, Bryan Richard Sasmita, Yuhe Zhao +4 more

Malnutrition and sodium water retention are some of the most common complications of chronic heart failure (CHF). To date, several parameters or risk stratification tools have been established to predict one's volume or nutritional status. Unfortunately, there is no biomarker that may reflect both conditions, thus, in this study, we established a novel biomarker known as total body water (TBW) to lean body mass ratio (LBM) ratio (TLR). Accordingly, we also assessed the prognostic value of TLR in CHF patients.

Multimodal evidence chain of iron overload, inflammation, and dysfunction: an integrated predictive model of early cardiac injury in pediatric transfusion-dependent β-thalassemia.

Panyan Zhou, Caili Li, Xiaomei Gao +3 more

Despite standardized transfusion and chelation therapy, children with transfusion-dependent β-thalassemia (TDT) remain at high risk for cardiac dysfunction due to iron overload. Conventional ejection fraction assessment lacks sensitivity for early injury. This study evaluated multimodal indicators to develop a robust early-warning model.

Analgesic use and changes in renal function in patients with heart failure in a real-world setting: a descriptive study using an electronic medical record database.

Ryo Ishida, Toshio Takano, Hironobu Tokumasu +1 more

To evaluate the incidence of analgesic use and changes in the estimated glomerular filtration rate (eGFR) of patients with heart failure (HF), with and without analgesic use in a real-world Japanese setting.

The Postoperative Course of Troponin T and NT-proBNP Levels in the Pediatric Population Implanted with the HeartMate 3 Device.

Şeyma Şebnem Ön, Zülal Ülger Tutar, Eser Doğan +13 more

Cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are key biomarkers reflecting myocardial injury and hemodynamic load in heart failure or after cardiac surgery. However, data on their postoperative course in pediatric HeartMate 3 (HM3) recipients are limited. This retrospective case series of ten pediatric patients aimed to evaluate the clinical significance of postoperative changes in these biomarkers.

Clinical Utility of Continuous Non-contact Cardiac Function Monitoring via Fiber-Optic Micro-Vibration Sensing System-based Myocardial Performance Index in Heart Failure Patients with Reduced Ejection Fraction.

Xiaoyan Wu, Jing Zhan, Chenze Li +7 more

Introduction Continuous monitoring of cardiac function may contribute to improving clinical outcomes in heart failure (HF) patients. A fiber-optic micro-vibration sensing system (FO-MVSS) that was previously developed by our group could make possible the non-contact and continuous measurement of the myocardial performance index (MPI) to assess cardiac function. However, the utility of MPI obtained by FO-MVSS (MPIFO-MVSS) in HF patients requires investigation. Methods Utilizing a case-control design, 72 HF patients and 72 control patients matched for age, gender and body mass index were recruited. Both FO-MVSS and echocardiography were used to measure the duration of the various phases of the cardiac cycle, thereby deriving the corresponding MPI. The MPIFO-MVSS of 23 hospitalized patients with HF was continuously monitored to evaluate its predictive value for the improvement of cardiac function. Results The MPIFO-MVSS was in excellent agreement with the MPI obtained by echocardiography (MPIecho) (intra-class correlation coefficient: 0.94, p<0.001). The MPIFO-MVSS exhibited statistically significant correlations with left ventricular ejection fraction (LVEF) (r=-0.78, p<0.001) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) (r=0.66, p<0.001). The MPIFO-MVSS had an excellent performance in discriminating HF patients from control patients, with an area under the curve (AUC) of 0.98 (p<0.001). Moreover, among continuously monitored patients, the change in MPIFO-MVSS was predictive of clinical outcomes (the kappa coefficient: 0.91, p<0.001). Conclusion Our study presents a novel approach to using non-contact MPIFO-MVSS for continuous cardiac function evaluation in patients with HF. The MPIFO-MVSS may serve as an accurate, sensitive, and non-invasive indicator of cardiac dysfunction.

Sleep-disordered breathing in patients with heart failure with preserved left ventricular ejection fraction.

Cornelia Grimm, Christian Viniol, Mikail Degerli +5 more

Data on sleep-disordered breathing (SDB) in patients with heart failure with preserved left ventricular ejection fraction (HFpEF) are sparse. Therefore, we aimed to determine the prevalence and characteristics of SDB in a large patient cohort with HFpEF.