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Diagnosing heart failure in centenarians.

ABSTRACT: Background:As a consequence of the demographic development with increasing proportion of older people, the prevalence of heart failure (HF) is expected to rise with considerable economic and societal costs. However, knowledge on cardiac structure and function among population-based samples of the exceptional old is lacking. Methods:Population-based study of all persons (no exclusion criteria) living in the western part of Denmark and turning 100 years in the year 2015. In-home face-to-face interviews were conducted, and echocardiography and blood sampling for plasma Brain Natriuretic Peptide (BNP) were offered to those who were able to give consent. Results:Out of 303 eligible, 238 (79%) participated, of which 125 (53%) accepted echocardiography. Left ventricular (LV) dysfunction was present in 68 (54%) of the participants of whom less than half had HF symptoms. Pulmonary hypertension was present in 31 (42%) with no correlation to LV function. The well-known association between increased level of BNP and the prevalence of LV dysfunction could not be confirmed. Conclusions:This in-home echocardiographic study shows that more than half of the participants had LV dysfunction, although mostly asymptomatic. There was no association between heart failure symptoms and LV dysfunction. Furthermore, BNP seems to have lost its biomarker potential to rule out heart failure in centenarians. Due to the latter, and the questionable symptom validity among centenarians, the current criteria to diagnose HF might be less valid in a centenarian population than in younger olds.

SUBMITTER: Rasmussen SH

PROVIDER: S-EPMC6379242 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Diagnosing heart failure in centenarians.

Rasmussen Signe Høi SH Andersen-Ranberg Karen K Dahl Jordi Sanchez JS Nybo Mads M Jeune Bernard B Christensen Kaare K Gill Sabine S

Journal of geriatric cardiology : JGC 20190101 1

<h4>Background</h4>As a consequence of the demographic development with increasing proportion of older people, the prevalence of heart failure (HF) is expected to rise with considerable economic and societal costs. However, knowledge on cardiac structure and function among population-based samples of the exceptional old is lacking.<h4>Methods</h4>Population-based study of all persons (no exclusion criteria) living in the western part of Denmark and turning 100 years in the year 2015. In-home fac ...[more]

PMID: 30800145

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Project description:ObjectiveTo evaluate the performance of B-type natriuretic peptide as a diagnostic tool for heart failure in pregnant or postpartum women with singleton gestations.MethodsWe conducted a retrospective study of diagnostic accuracy. We identified pregnant and postpartum women with B-type natriuretic peptide and echocardiography performed at an obstetric teaching hospital from 2007 to 2018. Women with known cardiac disease or multiple gestation were excluded. A panel of two cardiovascular disease experts, blinded to B-type natriuretic peptide values, determined the diagnosis of heart failure by consensus. Their judgement was based on detailed clinical features and parameters at the time of presentation with suspected heart failure. Where consensus could not be reached, differences were adjudicated by a third expert. A receiver operating characteristic curve estimated the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of B-type natriuretic peptide at various thresholds.ResultsIn total, 22 pregnant and 38 postpartum women were included in the cohort. Average age was 32±6.8 years. The most common clinical features at the time of presentation with suspected heart failure included preeclampsia (33/60, 55%), dyspnea (50/60, 83%), chest discomfort (34/60, 58%), and bilateral lower extremity edema (32/60, 53%). In total, 39 (65%) women had heart failure. The median B-type natriuretic peptide level was 326 pg/mL (interquartile range 200.5-390.5) in women with heart failure, as compared with 75.5 pg/mL (interquartile range 19-245) in women without heart failure (P<.01). The estimated optimal B-type natriuretic peptide cutoff was 111 (95% CI 78-291) pg/mL. Using this threshold, 45 (75%) women had an elevated B-type natriuretic peptide, which yielded a 95% sensitivity (95% CI 83-99), 62% specificity (95% CI 38-82), a positive likelihood ratio of 2.5 (95% CI 1.4-4.3), and a negative likelihood ratio of 0.1 (95% CI 0.0-0.3) for heart failure.ConclusionsB-type natriuretic peptide is a useful clinical tool to evaluate pregnant and postpartum women with suspected heart failure.

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Project description:BackgroundThe pathophysiologic heterogeneity of heart failure (HF) necessitates a more detailed identification of diagnostic biomarkers that can reflect its diverse pathogenic pathways.MethodsWe conducted weighted gene and multiscale embedded gene co-expression network analysis on differentially expressed genes obtained from HF and non-HF specimens. We employed a machine learning integration framework and protein-protein interaction network to identify diagnostic biomarkers. Additionally, we integrated gene set variation analysis, gene set enrichment analysis (GSEA), and transcription factor (TF)-target analysis to unravel the biomarker-dominant pathways. Leveraging single-sample GSEA and molecular docking, we predicted immune cells and therapeutic drugs related to biomarkers. Quantitative polymerase chain reaction validated the expressions of biomarkers in the plasma of HF patients. A two-sample Mendelian randomization analysis was implemented to investigate the causal impact of biomarkers on HF.ResultsWe first identified COL14A1, OGN, MFAP4, and SFRP4 as candidate biomarkers with robust diagnostic performance. We revealed that regulating biomarkers in HF pathogenesis involves TFs (BNC2, MEOX2) and pathways (cell adhesion molecules, chemokine signaling pathway, cytokine-cytokine receptor interaction, oxidative phosphorylation). Moreover, we observed the elevated infiltration of effector memory CD4+ T cells in HF, which was highly related to biomarkers and could impact immune pathways. Captopril, aldosterone antagonist, cyclopenthiazide, estradiol, tolazoline, and genistein were predicted as therapeutic drugs alleviating HF via interactions with biomarkers. In vitro study confirmed the up-regulation of OGN as a plasma biomarker of HF. Mendelian randomization analysis suggested that genetic predisposition toward higher plasma OGN promoted the risk of HF.ConclusionsWe propose OGN as a diagnostic biomarker for HF, which may advance our understanding of the diagnosis and pathogenesis of HF.

Dataset Information

Diagnosing heart failure in centenarians.

Publications

Diagnosing heart failure in centenarians.

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