Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic congestive heart failure (CHF) is associated with an increase in cytokines and inflammatory markers, particularly in elderly patients in whom chronic inflammation is generally present per se. In the present pilot study, neutrophil gelatinase-associated lipocalin (NGAL), a recently discovered cytokine, was analyzed together with different clinical and laboratory parameters in a small cohort of 46 elderly patients with CHF of various degrees. NGAL levels in the cohort were found to be significantly higher than in healthy age-balanced controls (458.5 [62.5-1212.4] vs. 37.8 [15.9-46.5] ng/mL; p = 0.0001). Furthermore, NGAL values increased in parallel with the clinical severity of CHF (New York Heart Association [NYHA] classification), the highest levels being reached in class IV patients (p = 0.0001). After a 2-year follow up, Kaplan-Meier curves indicated that patients with baseline NGAL > 783 ng/mL (best receiver operating characteristic [ROC]-derived cut-off value) had a significantly higher mortality (p = 0.001; log-rank test) and 4.08 hazards ratio (95% confidence interval [CI], 1.29-12.96) for death than the other subjects considered. Although preliminary, our findings suggest that NGAL plays a pivotal role in the systemic adaptation to chronic heart failure in elderly patients. Moreover, they indicate, for the first time, that measurement of NGAL may be of important prognostic value in the assessment of survival, thus extending the predictive properties of this cytokine beyond the clinical field of renal disease.
 ...
PMID:Increased plasma neutrophil gelatinase-associated lipocalin levels predict mortality in elderly patients with chronic heart failure. 1919 11

Heart failure and chronic kidney disease share a number of risk factors and pathophysiological pathways. Renal insufficiency is common in patients with chronic heart failure (CHF). The aim of the study was to assess whether neutrophil gelatinase-associated lipocalin (NGAL) could represent a novel, sensitive marker of kidney function in adult patients with chronic heart failure and normal serum creatinine. The study was performed on 150 patients with chronic heart failure due to coronary artery disease. Serum and urinary NGAL as well as serum cystatin C were measured using commercially available kits. Serum NGAL was related, in univariate analysis, to serum creatinine, urinary NGAL, hemoglobin, hematocrit, leukocyte count, eGFR, cystatin C. Urinary NGAL correlated with age, hemoglobin, hematocrit, serum creatinine, eGFR. In multiple regression analysis predictors of serum NGAL were NYHA class, cystatin C, and eGFR. Taking into consideration the fact that the recent DOQI states that individuals with a reduced GFR is at greater risk for cardiovascular disease and cardiac deaths, precise evaluation of renal function is important in order to select the appropriate strategy to reduce the cardiovascular risk. NGAL should be investigated as a potential early and sensitive marker of kidney impairment/injury.
 ...
PMID:Serum neutrophil gelatinase-associated lipocalin as a marker of renal function in patients with chronic heart failure and coronary artery disease. 1928 80

Today's patients present with a complexity of illness far more significant than ever before. Risk factors, in particular for cardiovascular, renal, and metabolic diseases, often interact with each other at core pathophysiological levels. Biomarkers are inexpensive tools that may help differentiate disease states in complex patients. Ideal biomarkers are both sensitive and specific to the disease state being examined. Natriuretic peptides are the prototype of ideal biomarkers and are adjuncts for the diagnosis and exclusion of heart failure in the dyspneic patient, especially those presenting with comorbidities such as lung disease. Just as natriuretic peptide levels can be considered the arbiter of congestive heart failure, cardiac troponins are decisive for myocardial necrosis. Novel assays with higher sensitivity will aid in earlier diagnosis, albeit with some decreased specificity. Nevertheless, the patient presenting with comorbidities and atypical symptoms of myocardial infarction will not be arbitrarily sent home. In the future, other novel biomarkers, such as neutrophil gelatinase-associated lipocalin for acute kidney injury, may come to the forefront for diagnosis of disease in the complex patient.
 ...
PMID:The utility of biomarkers in sorting out the complex patient. 2039 12

Neutrophil gelatinase-associated lipocalin (NGAL), a small 25 kDa stress-protein released from injured tubular cells after various damaging stimuli, is already known by nephrologists as one of the most promising biomarkers of incoming Acute Kidney Injury. Moreover, recent studies seem to suggest a potential involvement of this factor also in the genesis and progression of chronic kidney diseases. This brief review explores the new interesting involvement of NGAL in the experimental and clinical field of cardiovascular diseases, such as the pathogenesis and clinical manifestations of atherosclerosis, acute myocardial infarction and heart failure. It does not seem difficult that, in the next future, NGAL may become a new missing link between the kidney and the cardiovascular system.
 ...
PMID:From kidney to cardiovascular diseases: NGAL as a biomarker beyond the confines of nephrology. 2041 2

In the emergency department (ED) a prompt diagnosis and appropriate treatment for all diseases improve a patient's outcome. Acute kidney injury (AKI) is defined as an abrupt deficiency of renal function over a period of hours to days resulting in a failure of the kidney to excrete nitrogenous waste products and to maintain fluid and electrolyte homeostasis. AKI diagnosis could be very challenging for ED physicians because it is often very difficult to obtain some anamnestic data such as daily urine output or a preexisting value of BUN and serum creatinine. The incidence of AKI is progressively increasing in EDs and the mortality rates of these patients range from 50 to 80% in multiorgan failure. For ED physicians it is also crucial to distinguish AKI from prerenal azotemia (volume depletion promptly resolved through administration of fluids) at the time of patient presentation. Moreover, a rapid diagnosis of AKI leads to stop the progressive kidney damage on the basis of an appropriate therapeutic approach. Recent studies have demonstrated that by using a new biomarker, neutrophil gelatinase-associated lipocalin (NGAL), it is possible to obtain an accurate and fast diagnosis of AKI. It is well known that in patients with cardiovascular diseases such as stroke, coronary artery diseases and congestive heart failure, high levels of creatinine are strictly related to a higher mortality. In the ED the occurrence of AKI in patients with acute worsening of cardiac function like acute decompensated heart failure is very common. Moreover, managing acute heart failure strictly depends on renal function. Therefore, a multimarker approach including NGAL+BNP (today easily obtained by a POCT system) could have a tremendous impact on an appropriate diagnosis, treatment and a supposed better patient outcome. Furthermore, an evaluation of total body fluid content is of great utility. We propose a new model of management for ED patients with cardiorenal syndromes using a multimarker approach and non-invasive evaluation of body fluid content by bioelectrical impedance vector analysis.
 ...
PMID:How to manage cardiorenal syndromes in the emergency room. 2042 59

Chronic kidney disease (CKD) is frequently associated with a progressive decrease in the glomerular filtration rate, which leads to endstage renal disease (ESRD). Heart failure (HF) is a complex syndrome rather than a primary diagnosis, and considered as the endpoint of all cardiovascular disorders. It is the leading cause of death among the cardiovascular diseases in patients with CKD and ESRD. There is some interaction between the heart and kidney (the so-called "cardiorenal syndrome"), and HF patients with the complication of CKD or ESRD show a worse prognosis. Thus, early diagnosis and aggressive management of HF are needed in patients with CKD and ESRD. A number of biomarkers appear to have growing clinical importance and are reported for detection and stratification of HF. Although HF and CKD have a close interrelationship, the utility of the biomarkers has not been adequately studied with regard to the relationship with renal dysfunction. This paper reviews of the current evidence about laboratory biomarkers in patients with HF or CKD, emphasizing the emerging cardiac biomarkers (ie, BNPs and cardiac troponins), and the biomarkers of renal injury (ie, cystatin C and neutrophil gelatinase-associated lipocalin). Furthermore, it discusses the potential role of these markers in terms of heart - kidney interactions and their utility in the diagnostic and therapeutic strategies for cardiorenal syndrome.
 ...
PMID:Heart failure, chronic kidney disease, and biomarkers--an integrated viewpoint--. 2055 90

Biomarkers can provide insights into underlying mechanisms and lead to better understanding of complex disease states. This enhanced understanding can then be integrated into disease management, which can lead to better therapies and ultimately to improved patient outcomes. The natriuretic peptides (NPs) are established cost-effective biomarkers in heart failure and have set the standard for how a well-validated biomarker can be useful in the diagnosis/prognosis, monitoring of response to therapy, and management of chronic disease. Newer biomarkers such as midregional pro-adrenomedullin, ST2, and neutrophil gelatinase-associated lipocalin are emerging as adjuncts to NPs in the management of heart failure patients.
 ...
PMID:Biomarkers of heart failure. 2065 7

Cardiorenal syndrome (CRS) refers to pathophysiologic interaction of the heart and kidney and is associated with acute kidney injury (AKI) and high mortality. Cardiac surgery or acute decompensated heart failure and radiocontrast-induced nephropathy are common clinical scenarios of CRS. Unfortunately, established functional biomarkers of glomerular filtration rate such as serum creatinine, urea, and diuresis delay AKI diagnosis by 24 to 48 hours. Novel renal biomarkers indicating tubular injury are emerging and may have wide implications. This review focuses on several novel renal biomarkers with the most promising biologic characteristics and clinical evidence for their AKI predictive ability: neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, interleukin 18, and fatty acid-binding proteins. The value of each biomarker is reviewed on currently available clinical data in typical settings of CRS. These markers might extend the therapeutic window during which timely and individualized patient management might be possible.
 ...
PMID:Early biomarkers of renal injury. 2065 8

Heart failure goes beyond mechanical dysfunction and involves an interplay of multiple pathophysiologic mechanisms, including inflammation, tissue remodeling, neurohormonal and endocrine signaling, and interactions with the renal and nervous systems. This article highlights some novel biomarkers that may aid in diagnosis, treatment, and prognosis of acute heart failure, specifically focusing on ST2, endoglin, galectin-3, cystatin C, neutrophil gelatinase-associated lipocalin, midregional pro-adrenomedullin, chromogranin A, adiponectin, resistin, and leptin and their emerging clinical roles.
 ...
PMID:Novel biomarkers in acute heart failure. 2168 44

Cardio-Renal syndrome (CRS) is a common and complex clinical condition in which multiple causative factors are involved. The time window between renal insult and development of acute kidney injury (AKI) in acute heart failure (AHF) can be varied in different patients and AKI often is diagnosed too late, only when the effects of the insult become evident with a loss or decline of renal function. For this reason, pharmaceutical interventions for AKI that have been shown to be renoprotective or beneficial when tested in experimental conditions do not display similar results in the clinical setting. In most cases patients with AHF are admitted with clinical signs and symptoms of congestion and fluid overload. Loop diuretics, typically used to induce an enhanced diuresis in these congested patients, often are associated with a subsequent significant decrease in glomerular filtration rate and cause a creatinine increase that is apparent within 72 hours. Early detection of AKI is not possible with the use of serum creatinine and there is a need for a timely diagnostic tool able to address renal damage while it is happening. We need to define the diagnosis of both AHF and AKI in the early phases of CRS type 1 by coupling a kidney damage marker such as neutrophil gelatinase-associated lipocalin (NGAL) with B-type natriuretic peptide (BNP). Indeed, it would be ideal to make available a panel including whole blood or plasma cardiac and renal biomarkers building specific, pathophysiologically based, molecular profiles. Based on current knowledge and consensus, we can use kidney damage biomarkers such as plasma NGAL for an early diagnosis of AKI. However, differences in individual patient values and uncertainties about the ideal cut-off values may currently limit the application of these biomarkers. We propose that NGAL may increase its usefulness in the diagnosis and prevention of CRS if a curve of plasma values rather than a single plasma measurement is determined. To apply the concept of measuring an NGAL curve in AHF patients, however, assay performance in the lower-range values becomes a critical factor. For this reason, we propose the use of the new extended-range plasma NGAL assay that may contribute to remarkably improve the sensitivity of AKI diagnosis in AHF and lead to more effective intervention strategies.
 ...
PMID:Neutrophil gelatinase-associated lipocalin curve and neutrophil gelatinase-associated lipocalin extended-range assay: a new biomarker approach in the early diagnosis of acute kidney injury and cardio-renal syndrome. 2236 70


1 2 3 4 5 6 Next >>