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Published in: Cardiovascular Drugs and Therapy 1/2020

01-02-2020 | Artificial Intelligence | Original Article

Plasma BNP Levels and Diuretics Use as Predictors of Cardiovascular Events in Patients with Myocardial Infarction and Impaired Glucose Tolerance

Authors: Kazuhiro Shindo, Hiroki Fukuda, Tatsuro Hitsumoto, Shin Ito, Jiyoong Kim, Takashi Washio, Masafumi Kitakaze

Published in: Cardiovascular Drugs and Therapy | Issue 1/2020

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Abstract

Purpose

Although impaired glucose tolerance (IGT) promotes cardiovascular events, our Alpha-glucosidase-inhibitor Blocks Cardiac Events in Patients with Myocardial Infarction and Impaired Glucose Tolerance (ABC) study showed that alpha-glucosidase inhibitors do not prevent cardiovascular events in patients with myocardial infarction (MI) and IGT. The aim of the present study was to identify potential clinical factors for cardiovascular events in patients with MI and IGT.

Methods

Using the limitless-arity multiple testing procedure, an artificial intelligence (AI)–based data mining method, we analyzed 385,391 combinations of fewer than four clinical parameters.

Results

We identified 380 combinations predicting the occurrence of (1) all-cause hospitalization, (2) hospitalization due to worsening of heart failure (HF), (3) hospitalization due to non-fatal MI, and (4) hospitalization due to percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for stable angina among 385,391 combinations in 853 patients. Among these, either plasma BNP levels ≥ 200 pg/dl or diuretic use exclusively predicted (1) all-cause hospitalization, (2) hospitalization due to worsening of HF, and (3) hospitalization due to a non-fatal MI, with plasma BNP levels ≥ 200 pg/dl being the sole predictor of hospitalization due to PCI and CABG. Importantly, each finding was verified by independently drawn Kaplan–Meier curves, revealing the unexpected role of plasma BNP levels in the progression of coronary stenosis determined as the necessity of PCI and CABG for stable angina.

Conclusions

In patients with MI and IGT, high plasma BNP levels predicted the occurrence of coronary stenosis, recurrent MI, and worsening of HF, whereas diuretic use did not predict the progression of coronary stenosis but non-fatal MI and worsening of HF.
Literature
1.
go back to reference Braunwald E, Bristow MR. Congestive heart failure: fifty years of progress. Circulation. 2000;102(20 Suppl 4):Iv14-23.PubMed Braunwald E, Bristow MR. Congestive heart failure: fifty years of progress. Circulation. 2000;102(20 Suppl 4):Iv14-23.PubMed
4.
go back to reference Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am College Cardiol. 2012;60(24):e44–e164. https://doi.org/10.1016/j.jacc.2012.07.013.CrossRef Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am College Cardiol. 2012;60(24):e44–e164. https://​doi.​org/​10.​1016/​j.​jacc.​2012.​07.​013.CrossRef
6.
go back to reference Yamasaki Y, Kawamori R, Matsushima H, Nishizawa H, Kodama M, Kubota M, et al. Asymptomatic hyperglycaemia is associated with increased intimal plus medial thickness of the carotid artery. Diabetologia. 1995;38(5):585–91.CrossRef Yamasaki Y, Kawamori R, Matsushima H, Nishizawa H, Kodama M, Kubota M, et al. Asymptomatic hyperglycaemia is associated with increased intimal plus medial thickness of the carotid artery. Diabetologia. 1995;38(5):585–91.CrossRef
15.
go back to reference Schonbeck U, Mach F, Sukhova GK, Murphy C, Bonnefoy JY, Fabunmi RP, et al. Regulation of matrix metalloproteinase expression in human vascular smooth muscle cells by T lymphocytes: a role for CD40 signaling in plaque rupture? Circ Res. 1997;81(3):448–54.CrossRef Schonbeck U, Mach F, Sukhova GK, Murphy C, Bonnefoy JY, Fabunmi RP, et al. Regulation of matrix metalloproteinase expression in human vascular smooth muscle cells by T lymphocytes: a role for CD40 signaling in plaque rupture? Circ Res. 1997;81(3):448–54.CrossRef
16.
go back to reference Aikawa M, Rabkin E, Okada Y, Voglic SJ, Clinton SK, Brinckerhoff CE, et al. Lipid lowering by diet reduces matrix metalloproteinase activity and increases collagen content of rabbit atheroma: a potential mechanism of lesion stabilization. Circulation. 1998;97(24):2433–44.CrossRef Aikawa M, Rabkin E, Okada Y, Voglic SJ, Clinton SK, Brinckerhoff CE, et al. Lipid lowering by diet reduces matrix metalloproteinase activity and increases collagen content of rabbit atheroma: a potential mechanism of lesion stabilization. Circulation. 1998;97(24):2433–44.CrossRef
17.
go back to reference Tenerz A, Norhammar A, Silveira A, Hamsten A, Nilsson G, Ryden L, et al. Diabetes, insulin resistance, and the metabolic syndrome in patients with acute myocardial infarction without previously known diabetes. Diabetes Care. 2003;26(10):2770–6.CrossRef Tenerz A, Norhammar A, Silveira A, Hamsten A, Nilsson G, Ryden L, et al. Diabetes, insulin resistance, and the metabolic syndrome in patients with acute myocardial infarction without previously known diabetes. Diabetes Care. 2003;26(10):2770–6.CrossRef
18.
go back to reference Maier W, Altwegg LA, Corti R, Gay S, Hersberger M, Maly FE, et al. Inflammatory markers at the site of ruptured plaque in acute myocardial infarction: locally increased interleukin-6 and serum amyloid A but decreased C-reactive protein. Circulation. 2005;111(11):1355–61.CrossRef Maier W, Altwegg LA, Corti R, Gay S, Hersberger M, Maly FE, et al. Inflammatory markers at the site of ruptured plaque in acute myocardial infarction: locally increased interleukin-6 and serum amyloid A but decreased C-reactive protein. Circulation. 2005;111(11):1355–61.CrossRef
20.
21.
go back to reference Ogawa Y, Itoh H, Nakao K. Molecular biology and biochemistry of natriuretic peptide family. Clin Exp Pharmacol Physiol. 1995;22(1):49–53.CrossRef Ogawa Y, Itoh H, Nakao K. Molecular biology and biochemistry of natriuretic peptide family. Clin Exp Pharmacol Physiol. 1995;22(1):49–53.CrossRef
22.
go back to reference Omland T, Aakvaag A, Bonarjee VV, Caidahl K, Lie RT, Nilsen DW, et al. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide. Circulation. 1996;93(11):1963–9.CrossRef Omland T, Aakvaag A, Bonarjee VV, Caidahl K, Lie RT, Nilsen DW, et al. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide. Circulation. 1996;93(11):1963–9.CrossRef
24.
go back to reference Podgorelec V, Kokol P, Stiglic B, Rozman I. Decision trees: an overview and their use in medicine. J Med Syst. 2002;26(5):445–63.CrossRef Podgorelec V, Kokol P, Stiglic B, Rozman I. Decision trees: an overview and their use in medicine. J Med Syst. 2002;26(5):445–63.CrossRef
25.
go back to reference Kim J, Washio T, Yamagishi M, Yasumura Y, Nakatani S, Hashimura K, et al. A novel data mining approach to the identification of effective drugs or combinations for targeted endpoints--application to chronic heart failure as a new form of evidence-based medicine. Cardiovasc Drugs Ther. 2004;18(6):483–9. https://doi.org/10.1007/s10557-004-6226-y.CrossRefPubMed Kim J, Washio T, Yamagishi M, Yasumura Y, Nakatani S, Hashimura K, et al. A novel data mining approach to the identification of effective drugs or combinations for targeted endpoints--application to chronic heart failure as a new form of evidence-based medicine. Cardiovasc Drugs Ther. 2004;18(6):483–9. https://​doi.​org/​10.​1007/​s10557-004-6226-y.CrossRefPubMed
Metadata
Title
Plasma BNP Levels and Diuretics Use as Predictors of Cardiovascular Events in Patients with Myocardial Infarction and Impaired Glucose Tolerance
Authors
Kazuhiro Shindo
Hiroki Fukuda
Tatsuro Hitsumoto
Shin Ito
Jiyoong Kim
Takashi Washio
Masafumi Kitakaze
Publication date
01-02-2020
Publisher
Springer US
Published in
Cardiovascular Drugs and Therapy / Issue 1/2020
Print ISSN: 0920-3206
Electronic ISSN: 1573-7241
DOI
https://doi.org/10.1007/s10557-019-06922-9

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